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.

How should doctors and patients look critically at medical decisions?

Roy Benaroch, MD

Physician

August 16, 2013

The thing about science: it’s not a body of knowledge, or a list of facts. It’s a method. It’s looking at natural things, explaining them, and testing ideas to see if they’re right. More experiments (and better experiments) on more ideas leads to improved understanding and better ways to predict and influence what happens.

But science doesn’t go in a straight line. Not every study is valid, and not every idea …

Patients: Insist on being an equal and active partner in your care

Leana Wen, MD

Physician

August 16, 2013

It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis.

I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked.

My mind went blank. “Uh, I’m not sure,” I said.

“Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the …

The broken window theory in health: Examples of graffiti we can fix

Vineet Arora, MD

Physician

August 15, 2013

I just left the most unusual conference I have ever attended. First, it was small: 25 invited participants. Second, it was all women. Third, it was all women who have done amazing things …make that “trailblazing things.” They were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases, the most senior leader) at major federal and state health care agencies, Fortune 500 companies, large …

Should I avoid talking to my doctor and jump right to tests?

Davis Liu, MD

Physician

August 15, 2013

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

Do I really need an MRI? Do I really need blood work? This often? Should I avoid talking to my doctor and jump right to tests?

Americans love technology, whether it’s carrying the latest iPhone or buying the newest flat-screen TV with 3D technology. …

Dangerous online writing demands physician attention

Wendy Sue Swanson, MD

Physician

August 14, 2013

Simply not factual. That’s really all that needs to be said in response to Michael Edwards’ opinion piece entitled “Vaccine Side Effects and Why You Shouldn’t Vaccinate” published in Organic Lifestyle Magazine recently. This is clearly a non-peer reviewed, non-fact-checked online publication that Mr. Edwards edits and owns.

That being said, Edwards’ piece is so egregious I’m unable to hold my breath. Although I’m no watchdog, the dangerous writing demands physician attention partly …

When surgeons and patients don’t tolerate ambiguity very well

Bruce Campbell, MD

Physician

August 14, 2013

Do not now look for the answers … At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer.
-Rainer Maria Rilke

Two men, Ted and Ron, were long-term professional colleagues. I do not believe that they were particularly close, but they had been acquainted during their working lives. Each had retired.

In what was a remarkable coincidence, both men were diagnosed with …

After a medical mistake, an apology is both simple and difficult

Jim deMaine, MD

Physician

August 13, 2013

Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”

Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?

Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double shift, …

Hallways are no places for psychiatric evaluations

Greg Smith, MD

Physician

August 13, 2013

A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?

Well, as any of you know who have ever been to the ED for anything at all, once you get through the front …

Parenting and families: Are we focusing on the wrong debate?

Claire McCarthy, MD

Physician

August 12, 2013

We have got to stop talking about stay-at-home vs. working mothers as if it were some sort of debate, as if it were the central issue of parenting and families. It’s not.

I am really annoyed by an installment in The Debate, a blog on Huffington Post in which Lisa Heffernan says that she regrets being a stay-at-home mom. She laments her loss of income (which she clearly didn’t need), and that …

The first time a patient asked me how I was

Jennifer Stella, MD

Physician

August 11, 2013

It was the third year of medical school. Month two. First afternoon of my primary care clinic, first patient. I felt overwhelmed and unprepared until I saw the brief chart note for F. He’d had a positive tuberculosis test for an employment physical, with a follow-up negative chest x-ray, but he was required to be on intensive, two-drug treatment for six months to prevent developing the condition. This was the …

Medical malpractice claims drag on too long

Peter Ubel, MD

Physician

August 11, 2013

I am very fortunate to have never been sued. That is not necessarily because of my amazing ability as a physician. I always practiced in Veterans Affairs medical centers, where my status as a federal employee meant I would not get sued by my patients. I also had an incredibly appreciative patient population.

But I know that most of my physician peers have been sued, successfully or unsuccessfully, at least once …

Physician contracts and the female doctor

Linda Brodsky, MD

Physician

August 10, 2013

The healthcare workplace is undergoing profound changes. Where once a letter and a handshake were enough to create a life-long working relationship between colleagues, now the multiple work settings and relationships create many possibilities. Understanding not only how to get into the relationship, but also what might happen when you need to leave or are forced out of a relationship is critical.

True case report:

A woman internist arrives at work one …

Read more…

Physician contracts and the female doctor

Why a Miracle Whip advertisement is offensive

Dr. Charles

Physician

August 10, 2013

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I happened to see this Miracle Whip advertisement in a magazine left open by a patient in our waiting room, and I really found it offensive. Let’s dissect the ways in which this advertisement sullies the notion of food, and examine how far the concept of Miracle Whip strays from real food that should be enjoyed.

At the top of the page it …

The demand apathy that doctors increasingly face

Jordan Grumet, MD

Physician

August 10, 2013

Monday afternoons are always the same. I pick up the kids from their grandparents. We drive home with their backpacks and a carton of home made food. We park in the garage, and carry all the contents of the car into the house. As the kids unload, I push the recycle container to the front for street pickup the next day.

Occasionally, I stop and socialize. Yesterday, I waited at the edge …

The very best physicians do not judge their patients

James C. Salwitz, MD

Physician

August 10, 2013

It occurs to me there are several keys to being an excellent physician. One must love science, enjoy hard work, have the courage to make tough decisions, carry a modicum of intelligence and suffer angst at receiving 94% on an organic chemistry test. In addition, the very best physicians, those we admire and to whom we flock, have a secret weapon. They do not care.

I do not mean that they …

This was not a congenital deformity, but a preventable crime

Bhupesh Vasisht, MD

Physician

August 9, 2013

I started seeing patients the moment we arrived at Apollo Hospital in the small rural town of Bilaspur. There was no time to rest. These patients had been waiting for us for weeks to arrive. It was during this clinic time, on this day, that I realized something that really struck me to the core. I have been to India to do these missions many times. Heck, I have been …

To change health care, we need more physician leaders

Davis Liu, MD

Physician

August 9, 2013

There is a stunning gap between what we know and what we need to do in health care to make it more affordable, accessible, and higher quality. In a recent piece by NPR, research shows that when it comes to treatment of low back pain, doctors are prescribing more powerful pain medications (narcotics) and ordering more imaging tests like MRI and CT scans when there is no evidence these are …

Immunization workers murdered: The price of killing Osama bin Laden

Edward Pullen, MD

Physician

August 9, 2013

The price has been in lives. The capture and killing of Osama bin Laden occurred without loss of any U.S. military lives. It was hailed as a hugely successful special forces and intelligence operation. Still to believe that the operation was accomplished without the loss of life is both incorrect and naive. The lives lost have been those of polio vaccination workers murdered in the backlash against the use of …

When a doctor offers to speak the language of medicine for you

Miranda Fielding, MD

Physician

August 9, 2013

These days they have navigators for everything. When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas. …

Doctors need to place their families first

Neil Baum, MD

Physician

August 8, 2013

Several years ago I wrote an article for physicians on the topic of balance, and one of the suggestions was to place family first. There are two stories that I have learned since the publication of that article that I would like to pass along.

Balance in a doctor’s life is best achieved if there is balance between family and work. One of the best suggestions is to place …