Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the …
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Self-preservation: Why I abandoned clinical practice
For reasons I confess I don’t quite understand, zombies are in these days. They populate blockbuster movies, TV shows, and even commercials. There are the classic, grisly, menacing variety, and even some new-age variants that seem almost cuddly, in a creepy sort of way.
But whatever explains the fascination with zombies, they seem to belong to that same taxonomic category of interest as purple cows of silly poem fame: People …
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Our children will be living a growing number of zombie years
Childhood vaccination remains controversial among some non-physicians, in spite of being nearly universally recommended by physicians. If you spend some time on Google you will discover a whole world of websites where the issue, long settled in the medical community, is vigorously debated among non-experts. Of course a large component of this controversy is fallout from the now thoroughly debunked claims by Andrew …
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A strategy to approach patients who don’t believe in vaccines
Sexual abuse is shockingly common in the U.S. prison system. A recent survey conducted by the Bureau of Justice Statistics concluded that each year about 200,000 prisoners are victims of coercive sex.
Most of the those abused are psychiatric patients misplaced in prison. They make vulnerable targets — less able to defend themselves and less likely to be believed if they report infractions.
Prisons are clearly not an appropriate or safe place …
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The degradation prison life can hold for psychiatric patients
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.
Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …
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David and Goliath lessons for doctors and our health system
I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client (in this case, hospital) side of the equation. I’ve had the chance to speak with several executives (some were physicians themselves) about the overall process of hiring and managing temporary physicians. What I heard wasn’t pretty. I thought I’d summarize their opinions in the form of a mock composite …
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How do hospitals feel about locum tenens?
On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order — the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted.
Every step was deliberate, slow and painful. Whenever he …
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Tales of two nights before hip surgery
Recently I read an interesting article on leadership published at Inc.com. Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in medicine. In this article, author Curt Hanke writes about the inspiration and leadership positives found in the three simple words: “I don’t know.”
On first blush, we may think that a leader speaking these words may no longer …
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Admit when you fall short: The power of “I don’t know”
The use of gestational surrogates in India is a booming business, but is it ethical?
This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their genetically related offspring carried through pregnancy and birth by Indian women.
An estimated $500 million to $2.3 billion (U.S.) changes hands among commissioning couples, infertility clinics, brokers and Indian women who choose this way …
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Is the use of gestational surrogates in India ethical?
After you finish medical school classes, the night before graduation, they take you to a dark, quiet room. There, among leather bound tomes 300 years old, diseased skeleton trophies swinging behind glass, as you sip 50-year-old port in ancient crystal, they tell you the secrets.
This is the wisdom passed not in lectures, rounds or at the operating table; it is the hallowed legacy of thousands of healers over the millennia; …
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When treating male patients, watch the wife
He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …
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A new tagline for direct primary care
Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.
Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”
I pick up two sheets of paper with multiple questions including:
- discharge Medications: (list)
- present Medications: (list)
- diagnostic …
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Forms do not keep patients out of hospitals
A new study confirms what previous studies tell us. That a robotic hysterectomy is not a safer or a more efficient way to remove a uterus for non-cancerous (benign) surgery than a traditional laparoscopic approach. This study indicates that there is little difference between the two types of surgery with one glaring exception, a robotic hysterectomy was $2,489 more expensive than a laparoscopic hysterectomy.
Several months ago the American Congress of Obstetricians …
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Insurers should stop paying for robotic hysterectomies
What ever happened to courage?
Jim came through the cholecystectomy beautifully. In fact, he did so well that in no time he was back on the basketball court. Three weeks later he was in my office with a sore, swollen leg. He thought it was from twisting his ankle the day before. And indeed, it had all the appearances of a sports injury. I examined the extremity carefully, and decided to get …
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Physicians have lost their backbone
A few months ago my son asked if he could have a candy bar after dinner for dessert. My wife and I reminded him that he’d already had candy two days before and that we have a “one candy per week rule” in our house, so we said no. So he asked again. So we said no again. Then he asked yet again. And we said no again. Then he …
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Saying no to a child requires grit, self-control, and stamina
As a psychiatry resident with both a personal interest in meditation and a professional interest in integrating eastern mindfulness practices into western psychiatry, I like to keep up with the latest research on the subject. And I can’t help but notice how trendy the topic has become.
My last literature search turned up articles like “Pilot randomized trial on mindfulness training for smoking in young adult binge drinkers,” “Mindfulness-based program for …
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Why mindfulness has a place in psychiatry
Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …
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What an old doctor taught me about palliative care
I gave a patient my cell phone number today. I have been toying with the idea for a while and talking to various other physicians about how they handle it. We have a 24/7 chain of coverage so that a patient can call at any time of the day or night and reach a pulmonary/critical care physician. But not necessarily their physician, because, like everyone else, even doctors get days …
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Do you share direct contact information with patients?
In 2008, I gave the keynote address at the first “Diagnostic Errors in Medicine” conference, sponsored by the Agency for Healthcare Research and Quality (AHRQ). The meeting was filled with people from a wide variety of disciplines, including clinical medicine, education, risk management, cognitive science, and informatics, all passionate about making diagnosis safer. The atmosphere was electric. My lecture was entitled, “Why diagnostic errors don’t get any respect” (I wrote up the …
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We need better measures of diagnostic accuracy
Over the last month I have received several comments from readers who have or who are trying to make the choice between nursing and medicine. And may I just say what a great problem we have now, to be able to choose. I’ve been thinking about this and I submit there are three considerations: philosophical, practical, and logistical.
1. Philosophical. Many of you have heard of the “medical model,” the idea …
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Making the choice between nursing and medicine
