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.

Reflecting on DNR/DNI after being a code team leader

Robert Glass, MD

Physician

July 28, 2013

“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.”

It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit …

Suicide in female physicians: Recognize, respond, reconsider

Linda Brodsky, MD

Physician

July 28, 2013

More people are dying because they commit suicide than in motor vehicle accidents this year. The number of suicides is rapidly approaching the number of deaths from breast cancer. The trend upward has been noted for the past decade.

Physicians are the professional group with the highest rate of suicide. And studies have estimated that women physicians have as much as an eight fold rate of suicide compared to their male colleagues. Is …

In medicine, trust needs to be built in a matter of minutes

Scott Finkelstein, MD

Physician

July 27, 2013

I was a very shy child. I never felt comfortable speaking up, especially in groups or in new situations. When asked a question in class, my heart raced, my eyes teared up, and I felt sweaty. As I grew up, these physical reactions subsided as I learned to internalize and manage this fear. But at that time, I could not have imagined that my professional career would depend upon my …

The unwritten contract: Cancer cannot be beaten any other way

James C. Salwitz, MD

Physician

July 27, 2013

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

Physician

July 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what really happened while giving a history.

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

Why Congress should be responsible to fix mental health

Allen Frances, MD

Physician

July 25, 2013

The past months have been disastrous for mental health. One embarrassment has followed another — leading to a crisis of confidence that is potentially dangerous for those who rely on psychiatric care.

Most damaging were the negative reviews of DSM-5, the new diagnostic manual. It was justly panned for introducing many unsafe and scientifically unsound diagnoses that will worsen the already existing over-treatment of the worried well and the shameful neglect …

Cockpit culture and using the two challenge rule in the OR

Marjorie Stiegler, MD

Physician

July 25, 2013

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With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line. This isn’t a new concept, and isn’t unique to aviation. Many parallels have been drawn between aviation communication and healthcare team communications, …

Doctor bashing has become a national sport: How to stop it

Carla J. Rotering, MD

Physician

July 25, 2013

Doctors used to be among the most admired and respected persons in the community; now just a mention of this formerly revered title in a social setting will generate a totally different response.

Patients far too often will pour out stories of traumatic healthcare experiences, insults suffered, acts of disrespect or poor bedside manners, and disappointments in a system and in doctors who let them down. Doctor bashing has become a …

Separating work from home life makes for happier doctors

Arsheeya Mashaw, MD

Physician

July 24, 2013

One tired early morning, during my residency, I had been up all night in the ICU with a sick patient. Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about …

Behind the scenes of a total colectomy

Sid Schwab, MD

Physician

July 23, 2013

Next in a continuing series.

Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there’s music playing, that’s what I do when I operate. And for reasons about which I have absolutely no clue, I nearly always “whistle” The Caisson Song. I’ve always wondered if anyone …

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Behind the scenes of a total colectomy

A guide to giving bad news to patients

James C. Salwitz, MD

Physician

July 22, 2013

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.

A …

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A guide to giving bad news to patients

Check to see if your teen is texting when driving

Claire McCarthy, MD

Physician

July 21, 2013

I’m not big on spying on teens generally. I think that privacy is important. And by the time they are teens, in most cases we need to trust that at least some of the stuff we’ve said for years has stuck–and we need to let them learn to be independent and make choices without us.

That said, if you have a teen who drives, there’s some spying I suggest, assuming you …

Would C. Everett Koop be an effective Surgeon General today?

Peter Ubel, MD

Physician

July 19, 2013

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I have been thinking a lot about C. Everett Koop lately, ever since his death on February 25 at the ripe old age of 96 and more recently with the announcement that our current Surgeon General, Regina Benjamin, is planning to step down from that post. In particular, I have been pondering what made Koop such an effective Surgeon General, and what …

The words I say aren’t as important as my presence

Carl V. Tyler Jr., MD

Physician

July 19, 2013

I knew from last night’s house call that my patient Bessie’s time was near. All day long I’d felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn’t surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail.

It was Bessie’s daughter, Susan.

“Mom is gone,” she …

Confessions of a recovering doctor

Rob Lamberts, MD

Physician

July 18, 2013

Hi.

I’m Rob and I am a recovering doctor. Yeah, I am recovering … doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I …

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Confessions of a recovering doctor

What is the biggest mistake patients make?

Alex Lickerman, MD

Physician

July 18, 2013

The biggest mistake patients make isn’t what you think. It isn’t turning down tests or treatments their doctors recommend. Nor is it deciding not to take the medicines their doctors prescribe. It isn’t insisting on getting a test or beginning a treatment their doctors recommend against, either, and it isn’t failing to exercise, stay out of the sun (or use sunscreen), quit smoking, or lose weight. No, the biggest mistake …

Should a patient’s financial concerns influence physician decisions?

Michael Kirsch, MD

Physician

July 17, 2013

I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures. These folks need care that may be unaffordable. Medical diagnostic testing is expensive. Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing.

This absurdity is often …

The 3 biggest HIPAA myths debunked

Mary Pat Whaley

Physician

July 17, 2013

As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can’t place medical charts on exam room doors, you can’t use sign-in sheets, and you can’t leave messages on patients’ voice mail or answering machines.

Here, then are …

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The 3 biggest HIPAA myths debunked

Hospice care for the transgendered patient

Robert Killeen, MD

Physician

July 17, 2013

Hospice faces numerous societal obstacles in providing care for transgender patients. I recently witnessed a striking example of this in our local community hospice. An elderly individual assigned female at birth (MTF) was suffering from metastatic cancer. Chemotherapy had proven ineffective and had left her profoundly weak and infirm. With no connection to her family, she had only a few friends to rely on, but even they were only available …