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.

Financial advice for brand new doctors

Davis Liu, MD

Physician

September 1, 2013

This past July, the newest doctors, interns, have continued their journey in becoming experienced doctors. These newly minted and graduated doctors have excitement, anxiety, and anticipation not unlike the first day of medical school, college, or high school.

But as new doctors begin their next step, we rarely talk about those who also graduated. Specifically, doctors who have completed their residency and in some cases their advanced fellowship training. What about …

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Financial advice for brand new doctors

Can technology help individualized medical decision making?

Leslie Kernisan, MD, MPH

Physician

September 1, 2013

Shouldn’t everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision?

I was asked this question recently, during an interview for an Internet radio show on aging.

Per my host’s request, I’d been explaining the practice of geriatrics, and talking about the geriatric approach to addressing the medical needs of older adults. Since I’d mentioned that aging often brings on greater risk of side-effects or …

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

Physician

August 31, 2013

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

A huddle has the potential to change the way we care for patients

Fred N. Pelzman, MD

Physician

August 31, 2013

Having gotten all of the members of our team on board, how do we get them to actually get together?

We’ve all got busy days, all have lots of jobs to do, pulled in multiple different directions. The time needed to be thoughtful and really invest in the patient’s care is missing from our day. We need to make room for it, to get together, to really apply ourselves to …

Social networks influence parents’ vaccine decisions

Wendy Sue Swanson, MD

Physician

August 30, 2013

We live in a profoundly different time today when it comes to caregiving, parenting, and gaining health care/advice than we did even 5 or 10 years ago. The Internet has changed things dramatically.

During an interview recently a reporter asked, “You were raised on digital media, yes?” Well, no. I didn’t started using email until late 1995 just prior to leaving college, didn’t get a cell phone until I was teaching, didn’t …

In our efforts to be thorough, we are probably causing more harm

Hans Duvefelt, MD

Physician

August 30, 2013

Fear is more pain than is the pain it fears.
– Sir Philip Sidney

In our specialist age it has, in fact, become a major function of the general physician to examine thoroughly, to explain simply, to reassure as far as may be, and to protect his patients from unnecessary medical or surgical interventions.
– John A Ryle, MD, 1948 in the Journal of Mental Science, published by The Royal Medico-Psychological Association

Re-reading my …

After an adverse event: What should doctors disclose to patients?

Marjorie Stiegler, MD

Physician

August 30, 2013

What should doctors disclose to patients in the aftermath of adverse events? Does it matter if the adverse event was related to an error? Does it matter if it was preventable or not, anticipated or unexpected?

Recently, I was at the Carolina Refresher Course facilitating a session on adverse events in anesthesiology. We touched on a variety of issues, but spent the most time discussing the importance of disclosure conversations, as …

We must demand a return to meaningful notes

Robert Centor, MD

Physician

August 30, 2013

I had a nice conversation with a dermatologist at a party recently. He started complaining about the notes he receives from other physicians. He used terms like piles and piles of junk.

Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system.

Several years ago I ranted about the necessity …

Dear patients: My skill set no longer matches your needs

Jordan Grumet, MD

Physician

August 29, 2013

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Dear patients,

It has been a hard week. I wanted to take a moment to personally apologize for all that you have endured. As one who has witnessed your pains and struggles, I can only wince with each new passing hurdle you are forced to leap over. This business of disease and illness is not for the weak of heart (metaphorically, that …

Who accommodates a doctor with a disability?

Suzanne Koven, MD

Physician

August 29, 2013

In my practice, as in most medical practices, we accommodate patients’ particular needs in all kinds of ways: wheelchair accessible rooms and hallways, interpreters of virtually all languages including American Sign Language, gowns and instruments in a wide range of sizes, information sheets and videos suitable for patients with a variety of educational backgrounds.

No one questions the appropriateness of these accommodations.

But what about when the doctor or nurse requires an …

Why online dating is a bad idea for teens

Claire McCarthy, MD

Physician

August 29, 2013

Online dating is a bad idea for teens — especially young teens.

That’s why it wasn’t particularly responsible of Seventeen Magazine to publish a blog in which “dating blogger” Isabelle Furth floated the idea of using sites like Match.com to find dates. To be fair, she had concerns about the idea, and she’s in college, so theoretically old enough to make these decisions. But college kids don’t read Seventeen. Middle school …

The young doctor’s organized orientation to electronic dehumanization

Wes Fisher, MD

Physician

August 29, 2013

“It looks like you’ve done very well, Mr. Smith.”

“Thank you, doctor.”

He left the patient’s room and ambled back to the nurses station, legs tired and ankles somewhat swollen. It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day. He sat down at the computer and logged in. That’s when he looked up briefly …

How long do you continue to fight when death is certain?

James C. Salwitz, MD

Physician

August 28, 2013

Not long from now, the last cancer will be defeated, and even today most with the dread disease survive. However, many still fall. This leaves us with one of the toughest questions of life. How long do you continue to fight, when death is certain? When does striving become vain hope which drains quality and creates only suffering? What makes struggle worth the …

Choosing a doctor is like choosing a spouse

Kevin R. Campbell, MD

Physician

August 28, 2013

Just as in marriage, the ability to communicate is essential to any successful doctor-patient relationship. In fact, the most successful doctor-patient relationships are a lot like a marriage. Both parties must be willing to listen, to negotiate and to support each other’s decisions. Outcomes improve significantly when patients are engaged in their own healt hcare. Engagement only occurs when doctors and patients are able to effectively work together to solve …

The fall and recovery of a cardiac surgeon

Larry Zaroff, MD, PhD

Physician

August 26, 2013

Four months after having a knee replacement, I stumbled into the bathroom at 3am, not fully awake, hoping to urinate.

Losing my balance, I fell. The result was a compound fracture of my left leg — the one with the prosthetic knee.

Gazing at my shiny white kneecap, I lost all logic, all control. I simply cried.

At eighty, I was unprepared for this unexpected anatomy lesson: my twenty-nine years as a surgeon …

What I learned from my mother’s hospital admission

Robert Wachter, MD

Physician

August 26, 2013

A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.

Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized …

Know the human being behind the diagnosis

Miranda Fielding, MD

Physician

August 26, 2013

When I was a resident in radiation oncology, I thought I already knew a lot about medicine. After all, I had just completed an internal medicine residency, and had taken and passed my boards. Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code …

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

Physician

August 26, 2013

acls

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

Calling a consult: Disrespect from specialists hurts patients

Heidi Roman, MD

Physician

August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

Hand hygiene in hospitals has gone too far

Karen S. Sibert, MD

Physician

August 26, 2013

We’ve run amok with wearing gloves in the hospital. And by “we” I mean every healthcare worker in sight. I see people putting on gloves before they’ll give a patient a clean warm blanket. This is not only ridiculous, it’s actually harmful. Here’s why.

We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the …