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.
Recently, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating “so-called superbugs.” In this USA Today article, it states that superbugs “cause at least 2 million infections and 23,000 deaths each year.”
You know who is causing the problem, right? It’s doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you …
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We lack the will to solve antibiotic resistance
The latest salvo in the federal government’s war on physicians comes to us courtesy of the Veterans Health Administration (VHA), which is proposing drastic policy changes to expand nursing scope of practice in all veterans’ hospitals.
A new draft VHA Nursing Handbook would eradicate all existing VHA policies concerning physician supervision, and would designate all advanced practice registered nurses (APRNs), including nurse anesthetists, as licensed independent practitioners (LIPs). This means that …
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The latest salvo in the federal government’s war on physicians
After finishing medical school and my residency in internal medicine, I undertook an additional year of training in a field called palliative care. Patients who notice my background sometimes ask me what exactly palliative care means. It’s really a simple concept. Palliative care is helping people with a serious illness have the best possible quality of life. It’s enabling sick patients to make the most of the time they have left …
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Defining the 3 goals of palliative care
So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?
Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who …
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Going all the way should mean more than completing high school
On September 17, 2013, I joined the growing ranks of physicians who have gotten a message they hoped never to receive: “There has been a mass shooting in the area. Prepare to receive casualties.”
That morning, a gunman was indiscriminately mowing down people at the US Navy Yard. Within an hour my hospital had geared up to provide both medical and supportive care, answer calls from those seeking to know the …
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Unregulated gun access and its drain on medical resources
An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.
There is also said to be evidence showing that in one day he was doing as many …
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3 stories of surgeons that I find disturbing
I was naive when I decided to enter medicine. My impressions then were that doctors always “did” stuff — for patients, and to patients. We would do stuff to you (examinations, blood tests, scans, surgeries) in order to help you.
A lot of time and education later, I’ve learned that that straightforward paradigm is far from the only way that doctors help people. In fact, following that mostly simple formula (you come to us, we do stuff to …
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Being good doctor requires bearing witness
You are taking care of a patient with metastatic pancreatic cancer. The disease has spread, surgery is not an option and second line chemotherapy has failed. He is in pain, but is poorly compliant with narcotic directions. He keeps falling down the stairs. His wife cries all the time. The family is desperate for help. The patient is in the office with loved ones, looking for guidance.
“What do we do …
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Hospice also saves the doctor
We were pretty damn lucky that she was young and healthy.
The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.
It was a routine hysterectomy. None of the pizazz and flare of a gynecology-oncology surgery, but …
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With the patient hemorrhaging, doctors are backed into a corner
So what exactly do we want a patient-centered medical record to look like?
What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.
If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …
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How can we revise the patient medical record?
A Bank of America ATM can figure out who you are and how much money is in your account in seconds. It can spit out cash in virtually any currency from nearly any spot in the world — even if you’re a Chase customer. It’s a technological convenience we’ve all come to expect.
Hospitals and doctors’ offices are starting to replace hard copy patient records with computerized heath systems. Some U.S. …
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Who will pressure physicians to join the 21st century?
There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.
Stark and …
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The horror and beauty of performing an amputation
Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
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What to do after you make a medical error
Walking into each room to greet my next patient often reminds me of Forrest Gump: “You never know what you’re going to get.” It’s challenging to have only one chance to get it right but I love being an emergency room doctor.
Today, an older lady has slipped at home and she’s taped to a hard backboard with a rigid neck collar in place. It’s routine for all patients involved in …
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Why I love my job as an emergency physician
On a warm and sunny August Sunday, I was rollerblading with my kids on the Shining Sea Bikeway. On mile nine on the trip, I hit a tree root, went flying, and landed on my shoulder. I could tell immediately that something was wrong — I couldn’t move my arm and was in the worst pain of my life. Feeling for my left shoulder, it was obvious that I had …
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My patient experience wasn’t an outlier
My new glasses were years overdue. The eye doctor understood perfectly my request that the focal point and pupillary distance for my iPad reading glasses had to match my habitual reading style – right under my nose. The result couldn’t be more pleasing.
The other day my wife squinted over her iPad and said “I don’t know if I’m getting a cataract or if I just need new glasses. My right …
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Balance bedside assessment with high-tech testing
Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …
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Would every profession consent to returning fees for mistakes?
She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.
So …
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This is the grim reality of starting a private primary care practice
As I travel around the country, working in the trenches of various hospitals, I’ve been struck by the number of errors made by physicians and nurses whose administrative burden distracts them from patient care. The clinicians who make the errors are intelligent and competent — and they feel badly when an error is made.
However, the volume of tasks required of them in a day (many of which are designed to fulfill …
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Intelligent information synthesis is the basis of error prevention
