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 American Congress of Obstetricians and Gynecologists (ACOG) issued a recently regarding legislative interference and health care decisions. Specifically, the release states that: “Government should not interfere with the patient-physician relationship without a substantial public health justification.”
The full Statement of Policy was approved by ACOG’s Executive Board. Some recent examples of government interference include mandatory age requirements for Plan B, transvaginal ultrasounds before abortion, prohibiting doctors from asking about firearms, …
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We allow the legal system to contaminate evidence based guidelines
Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer …
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I failed to appease pain during her life, so she died terribly
Vermont became the first state to enact a law authorizing physician-assisted suicide through the legislative process. As the governor signed the bill, Jean Mallary watched carefully over his shoulder. She’s the widow of the late Dick Mallary, a former speaker of the House and U.S. Congressman. Mallary was in pain and suffered from terminal cancer when he chose to end his life over a year ago. Jean Mallary’s story …
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Death with dignity: Issues states need to consider
It was my second day of residency, and something was afoot. As I made my way around my first rotation on the cardiac floor, my medical senses were tingling. There was something strange happening to all of my patients, I saw. As I peaked over my cohort’s shoulders, I secretly saw that it was happening to their patients too, though they hadn’t seemed to notice.
Only I did, and I was …
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Bad data: When everyone breathes at the same rate
The sudden illness of a colleague is always a shocking surprise. As physicians, we are trained from an early age to ignore our own infirmities in the service of others. Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for …
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When the weight of illness suddenly descends on an individual
As a little boy I had a dream that I have always wanted to join the circus. I thought for sure I could be a clown or even the ringmaster. At age 34 a friend who did public relations for Ringling Brothers and Barnum & Bailey Circus gave me the opportunity to make my dream come true and I was invited to be a clown in the circus.
The show was to …
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Physicians: Learn to pick up the proverbial poop
In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …
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Why doctors should take sabbaticals
Patient safety and hospital quality is a scary topic. I’ll go easy. I’m just a doctor. I don’t know much.
Entire departments, filled with cubicles, computers and well-meaning people, now exist to keep hospitals tightly regulated and running perfectly. There is data to analyze, regulations to read, and oh so many meetings to attend. This place of healing will be safe—and perfect.
The …
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Does alarm fatigue really kill?
On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.
1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as …
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Reflections after 4 years of emergency medicine training
It’s not surprising that physicians fear lawsuits, as more than 61 percent of doctors older than 55 have been sued at least once, according to the American Medical Association.
But is this fear completely justified? I believe that the media tends to sensationalize malpractice with stories about high judgments and horrific cases.
The facts are this:
In practicing medicine, offense wins championships
There was the time I was hugging a trashcan in the lobby of the community hospital ED just a few blocks from my house. Not because I have a molded plastic fetish or because I like the smell of trash, mind you. I had an itinerant renal calculus, otherwise known as a kidney stone that was moving through my urinary system.
It. Hurt. Like. Hell.
I. Wanted. To. Die.
I was throwing up …
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For psychiatric patients in the ED, waiting is the hardest part
Several years ago I cut my hand badly on a broken glass and required surgery to reattach a tendon. For a few weeks after the operation, I attended regular sessions in a physical therapy department devoted to people with hand injuries. There were no closed curtains in the large therapy room — we bared only our hands, after all. As I had my fingers warmed, splinted, or stretched, I observed …
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Education that occurs among patients in a group
This past weekend I spent time relearning some life lessons.
On Saturday, I picked up a couple screens from the hardware store to reinstall them after they were nearly destroyed by our neighborhood bear. The bear seems to think she will find the birdfeeder that used to hang nearby, so she stands on our deck and leans on whatever is nearby (our screened porch) while she looks for it. Then she heads …
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Overcoming the resistance to same day appointments
Henry Morgentaler died recently. He was the man who almost single handedly brought down the Canadian abortion law. Sickened by what was happening in filthy, clandestine clinics he began doing safe, albeit illegal, procedures in his office. He was arrested but always maintained that a jury would never find him guilty. And he was right.
Years later when I was in medical school and then residency I marveled at …
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The man who brought down the Canadian abortion law
One of the benefits of being an oncologist is that, as a rule, people appreciate our work. That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s sounds like fun!”
Nonetheless, at least there is a modicum of respect. However, I found a group of people with major questions about the work of cancer docs or at least …
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The tension between oncology and palliative care
Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated resources — too much testing and treatment for people who don’t need it and lousy access for many who do.
The impact of advances in medical science on the delivery of …
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Confronting the reality of uncertainty in medicine
By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. …
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Nelson Mandela: Recognize the end of life equation
Our culture — at least the movie-going part of it — seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered.
After …
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The power of culture in health care
