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.

The role of physicians is set to evolve again

Hans Duvefelt, MD

Physician

September 11, 2013

Talking with an insurance doctor, who denied a vertebroplasty for my patient with a spontaneous compression fracture, I started thinking about the dilemma of defining what a doctor-patient relationship is.

A couple of years ago a local doctor with a dwindling private practice joined an Internet medical site that promoted drugs like Viagra and offered online consultations with physicians who prescribed the medications when they felt it was appropriate. The state …

What keeps this hospital CIO up at night

John Halamka, MD

Physician

September 11, 2013

Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face.

1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers. As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, …

What Jay-Z can teach doctors about marketing their practice

Mary Pat Whaley

Physician

September 11, 2013

Do you know who Jay-Z is?

If not, chances are your kids do. Jay-Z is one of the most successful rap artists of all time, and has parlayed that success into a career in fashion, merchandising, his own line of vodka, as well as an ownership stake in the NBA’s New Jersey Nets franchise that he recently sold to begin a new career …

Bluffing wasn’t a skill I was expecting to master in pathology

Gizabeth Shyder, MD

Physician

September 10, 2013

As a pathologist, I am one step removed from the patient. This is comforting for the most part. I render my diagnosis and another clinician communicates it to the patient. It is best this way — I have no treatment options in my own doctor toolbox to give meaning to the words I communicate. I learned this the hard way — in fellowship training.

Once I was doing a fine needle …

Don’t confuse death with dignity with suicide

Peter Ubel, MD

Physician

September 9, 2013

In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide. Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards: multiple requests for example, determination of competency, and the like. Then, if the patients so choose, they can ingest …

A gastroenterologist dishes on unnecessary colonoscopies

Michael Kirsch, MD

Physician

September 9, 2013

We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.

We are the scope doctors.

We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …

Urging doctors to take responsibility for their mistakes

Manoj Jain, MD, MPH

Physician

September 8, 2013

In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.

Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors …

7 tips to stay away from misery on vacation

Ronan Kavanagh, MD

Physician

September 7, 2013

This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have traveled as well as we have.

I always get excited about going. There’s the anticipation of downtime away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just …

Laws based on fetal pain are being dressed with pseudoscience

Jennifer Gunter, MD

Physician

September 6, 2013

10 years ago today my first son was born and 10 years ago today he died.

Born at 22 1/2 weeks he lived for three minutes, at least that’s what was written on the certificate that they gave me at the hospital. It seemed like both hours and seconds.

It was very anticlimactic in a way. I don’t say this to be trite, but it was as if his motor just stopped …

Is there an acceptable way to end friendships?

Alex Lickerman, MD

Physician

September 6, 2013

When I was in first grade, my teacher once called the class together and said, “Glen is feeling bad because no one will play with him. Will anyone here play with Glen?” Glen was new (I think he moved to the area mid-year) and awkward-looking, and I remember how bad I felt for him when she said that. So I raised my hand. “I’ll play with Glen,” I said. To …

Billing for end of life conversations needs to be an honest discussion

Shirie Leng, MD

Physician

September 5, 2013

Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of …

The difficult transition between the hospital and nursing home

Ken Covinsky, MD

Physician

September 5, 2013

nursing_home_abuse

Huge numbers of older persons transition from hospitals to the nursing home. Often, an older hospitalized patient needs skilled nursing care before they are ready to return home. In other cases, a nursing home patient who needed hospitalization is returning to the nursing home. Older patients and their families certainly hope that great communication between the hospital and nursing home would assure …

Treating cancer patients puts everything else into perspective

Miranda Fielding, MD

Physician

September 5, 2013

When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very …

10 questions to ask before anesthesia

Karen S. Sibert, MD

Physician

September 4, 2013

A guest column by the American Society of Anesthesiologists.

Not so many years ago, surgeons wouldn’t operate on patients they considered too old to tolerate the stress of anesthesia and surgery. Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures.

Realistically, even if you believe …

Read more…

10 questions to ask before anesthesia

The knowledge that one wasn’t alone in an uphill fight

StorytellERdoc, MD

Physician

September 3, 2013

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother’s home. From a distance, the scent of smoke was just that — charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories …

The hubris of medicine has to end

John Mandrola, MD

Physician

September 3, 2013

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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The hubris of medicine has to end

Can telepsychiatry really work?

Greg Smith, MD

Physician

September 2, 2013

I have been asked one question about my work in telepsychiatry more that any other, hands down.

“Can you really help a mental health patient like that, through a television screen?”

The quick and dirty answer? Yes, absolutely.

The extended answer? Read on.

Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I …

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Can telepsychiatry really work?

Why hospice is special to me

Kristina Newport, MD

Physician

September 2, 2013

When socializing with fellow young physicians, most of whom are not in palliative medicine, I am reminded that I have the unique opportunity to share time and attention with my patients. We reflect on “the old days” of medicine, where physicians had long standing relationships with their patients which allowed them to more easily direct medical decision making which was appropriate for the individual patient. I often tell others I …

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Why hospice is special to me

Is the end near for small community hospitals?

Mike Sevilla, MD

Physician

September 2, 2013

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Recently, a local story happened that made me think of this.

The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.

Six months …

When I see young pregnant patients, I see potential and opportunity

Jeff Livingston, MD

Physician

September 2, 2013

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is not a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy. Pregnancy did not stop her from succeeding. My wife tells the story of riding …

Physician

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