Physician

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.

Delivering bad news: A vast divide between doctor and patient

James Marroquin, MD

Physician

September 18, 2013

My wife recently read me her journal entry from the day our younger son turned two years old. She had written quizzically that he had still not spoken any words despite a good deal of speech therapy. For months previous to that birthday, he had also been engaging in repetitive, obsessive behaviors. He walked circuits around the couch with total concentration, oblivious to the rest of his surroundings. If you …

When a physician resorts to jargon, educating patients can fail

Peter Ubel, MD

Physician

September 18, 2013

The urologist broke the news: “Out of 12 cores, three were positive for cancer, so you have a small amount of cancer.”

He would soon explain the treatment choices — surgery, radiation, or active surveillance (watching the cancer closely with blood tests and biopsies). He described each option in elaborate detail, because he knew that the “right choice” would depend on what his 70-year-old patient thought about the pros and cons …

Doctors shouldn’t criticize other physicians in front of patients

Kevin R. Campbell, MD

Physician

September 18, 2013

We all try to do our very best for our patients. Often the decisions we make have profound impacts on outcomes. Medicine is not always cut and dry, and many times gut instinct and judgement calls must play a role in choosing therapies for patients (especially when made in the setting of best available data). As it is in most professions, Monday morning quarterbacking frequently occurs in medicine as well. It is …

The Sunshine Act: A chilling effect on medical education?

John Mandrola, MD

Physician

September 17, 2013

Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels.

What follows are some thoughts about how the Sunshine Act might play out.

Every Thursday during my cardiac fellowship training, at noontime, the entire department gathered for an hour-long conference on echocardiography. Unknown …

I’m grateful that I’ve been given a second chance

Mitch Kaminski, MD

Physician

September 16, 2013

My patient Maria sits before me, looking vaguely distressed.

She’s returned for a follow-up visit, six weeks after our first. The morning is half over, and I’m clipping along, staying on time, using the new electronic medical record system (EMR) without a glitch and with a sense of satisfaction. Three months back, when I joined this small-town practice as part of my new position as a health-system medical director, I found …

In the midst health care cynicism, an affirmation of enduring love

Miranda Fielding, MD

Physician

September 16, 2013

When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.” Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it. But just in case — the story is about a young couple, poor and deeply in love. At Christmas, they have no …

Painting in the OR: The evolution of surgical preparation

David Gelber, MD

Physician

September 16, 2013

One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts.

I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and …

ACP: Raising the profile of internal medicine

Yul Ejnes, MD

Physician

September 16, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

ACP recently launched a campaign to celebrate and increase awareness of internal medicine, the “I.M. Proud to Be an Internist” campaign. If you visit the website, you will find a summary of the campaign’s goals, information for patients and families, links to downloadable posters for the office, and merchandise that …

Ariel Castro: That could be your patient they’re talking about

Annette Hanson, MD

Physician

September 16, 2013

I thought I’d share what I saw on my Twitter feed as soon as I got up recently. I immediately felt a blog post coming on, particularly after reading the Twitter comments as they rolled in. I felt a bit sick, knowing what some of my colleagues in Ohio must be going through right now. This post is for you.

When it comes to patient suicide, correctional psychiatry is probably one …

The lessons of Annie Dookhan can apply to every laboratory

The Pathology Blawg, MD

Physician

September 15, 2013

1101_Dookhan

The attorney appointed by Massachusetts Governor Deval Patrick to investigate the case of Annie Dookhan, the Massachusetts state drug lab chemist who allegedly faked test results, tampered with evidence and neglected protocols over a several year period, now states more than 40,000 cases may have been affected.

So far the state has released 330 inmates and dismissed or declined to prosecute more than 1,100 other cases as …

Primary care doctors: It’s time to celebrate our generalization

Dr. Richard Cook

Physician

September 15, 2013

1984 was a great year — not just for George Orwell lovers, or for me as I embarked on my medical education. Daley Thompson won his second Olympic gold medal in the decathlon event, and in securing his place in athletics history also broke the world record. Picture the scene afterwards if you can, as journalists jostled to talk to the great man draped in Union flags and his gold …

MD vs NP: Principles for a civil online discourse

John Schumann, MD, Anna Reisman, MD, and Matthew Freeman, DNP, MPH

Physician

September 15, 2013

For busy and opinionated physicians, online comments are both catharsis and a form of self-expression. After all, doctors are in the thick of it. We see how policies affect our patients. We know how politics affect our profession. While traditional editorials require time, editing, and an editor’s decision to publish the piece, online comments provide an easy and instantaneous way for even the most overworked and harried physicians to vent …

The difference between health care and disease management

Natasha Deonarain, MD, MBA

Physician

September 14, 2013

It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.

The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.

But because of its …

What does it mean to be a doctor and a patient?

Rebecca Crow, DO

Physician

September 14, 2013

It is a doctor’s duty to take care of patients as has been our job since the first physician quoted the Hippocratic Oath. However, what happens if this distinction becomes somewhat blurred? What does it mean to be a doctor and a patient?

An experiment I inadvertently took on after feeling sick the night prior to my last day of wards. In my most resilient form I pushed forward with the …

They say every physician has a graveyard

Freida McFadden, MD

Physician

September 14, 2013

An excerpt from The Devil Wears Scrubs.

They say every physician has a graveyard.

Mine may eventually contain Dr. Alyssa Morgan.

Watch out, Alyssa.

Sometime in July

Time: 3 a.m.
Hours awake: 21
Chance of quitting: 75%

This patient is the fattest man I’ve ever seen in my life. His name is George Leeman and he’s got fat …

The future of geriatrics: Questions to consider

Leslie Kernisan, MD, MPH

Physician

September 13, 2013

Recently, the New York Times featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice.

It has generated quite a lot of comments. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care …

Dissection of a needless hospitalization

Jordan Grumet, MD

Physician

September 13, 2013

If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.

The cardiologist hemmed and …

End of life care is a core part of medicine

James C. Salwitz, MD

Physician

September 13, 2013

Recently, I continued my crusade to make end-of-life care a basic skill, as I gave the “Introduction to Dying” lecture to third year medical students, for the twentieth time. For me it is not just about pain control, family meetings and hospice care, but rather convincing physicians that they must change the medicine practiced for the last 100 years. That medicine says that a doctor can fight all disease, give any treatment, …

What keeps some people from feeling that they really matter?

Greg Smith, MD

Physician

September 12, 2013

“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.”

A toothless grin.

“It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? …

Lawyers are a big impediment to disciplining bad doctors

Skeptical Scalpel, MD

Physician

September 12, 2013

If you are interested in patient safety and medical errors and haven’t read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe.

The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch.

The Texas Medical Board is over-worked, slow to act and …