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.

It’s time to treat mental illness in the ER with dignity

Greg Smith, MD

Physician

May 23, 2013

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …

Practice hassles are threatening our profession

Robert Centor, MD

Physician

May 23, 2013

Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external transformation of our wonderful profession.

We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and …

Why banning curbside consults may not be the answer

Robert Wachter, MD

Physician

May 22, 2013

Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare.

Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the underlying facts and assumptions aren’t right (the old garbage in, …

A surgeon interviews a medical malpractice attorney: Read and decide

Jeffrey Parks, MD

Physician

May 22, 2013

My interview series continues, this time with local litigation attorney Andrew Thompson, Esq. The topic this time is medical malpractice. I asked him a bunch of questions. He answered. See what you think.

1. In your opinion, is there a medical malpractice crisis in this country?

No. This is not even a close issue. The concept of a “crisis” or dramatic increase in the number of medical malpractice cases is a fabrication …

How can patients voice discomfort with excess services?

Ishani Ganguli, MD

Physician

May 21, 2013

The cabdriver pulled up to take me to the community hospital where I work several weeks each year. Settling into the back seat, I made my request before he reached the intersection: “Could you please take 93 South?” He was quick to ask me why, and I hesitated. I had taken this route dozens of times and had usually found it to be faster than the alternative, I said, but …

Will high tech innovations actually improve health outcomes?

Kenneth Lin, MD

Physician

May 21, 2013

One of my students told me about his experience at TEDMED, the future-oriented medical conference that bills itself as “a celebration of human achievement and the power of connecting the unconnected in creative ways to change our world in health and medicine.”

He recounted how one speaker showed off the Remote Presence Virtual + Independent Telemedicine Assistant, which news outlets quickly dubbed the “Robo-Doc.” This high-priced gadget is designed …

Why physicians need to write

Louise Aronson, MD

Physician

May 21, 2013

Should doctors be able to write?

At first glance, this might seem like a question with an easy answer.

Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in their lives. Or you could reply, No, they are scientists and so need to be functional communicators able to write basic notes and prescriptions, and …

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Why physicians need to write

Science alone can’t make tough decisions for us

Peter Ubel, MD

Physician

May 21, 2013

On April 14, The United States Preventive Services Task Force concluded that women with an elevated risk of breast cancer – who have never been diagnosed with breast cancer but whose family history and other medical factors increase their odds of developing the disease–should consider taking one of two pills that cut that risk in half. The Task Force is an independent panel of medical experts who …

Why we cannot keep the costs of end of life care in a reasonable range

Steven Reznick, MD

Physician

May 21, 2013

“J.T.” is 92 and clearly a soul who lives to the beat of a different drummer. She has no children and her closest relative is a niece who she despises. Despite this the niece oversees her care, sending in a full time aide and her personnel assistant to run the household. J.T. will not come to the office for a visit. If I call and make an appointment to see …

I believe we can find and promote joy in primary care

Christine A. Sinsky, MD

Physician

May 20, 2013

A few years after I entered my practice as a newly certified internist, about two decades ago now, I started to burn out. I felt I was becoming a documentation drone and a guideline-following automaton. I was embarrassed for some of the care I gave–attempting to fit patients’ round needs into the square peg of the medical model. Patients who came to talk about depression were marched through a complete review …

Bringing OpenNotes to Geisinger

Jon Darer, MD

Physician

May 20, 2013

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each …

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Bringing OpenNotes to Geisinger

America is at war with its doctors, and patients are the losers

Mona Kotecha, MD

Physician

May 19, 2013

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Not old enough to remember any sort of “glory day” in medicine, I still enjoy hearing from older colleagues who recount days when they were respected, paid fairly, and able to practice medicine autonomously at the highest and most uncompromising level. What was that like, I wonder?

For five years, I’ve been a busy practicing anesthesiologist. And for five years, I’ve listened …

Medical mistakes occurred at all levels of my care

Itzhak Brook, MD

Physician

May 18, 2013

Medical and surgical errors are very common in the hospital setting. They increase malpractice lawsuits, the cost of medical care, patients’ hospital stays, and morbidity and mortality. As an infectious diseases specialist for over forty years, I was not aware how common these errors are until I became a patient myself after being diagnosed with hypopharyngeal carcinoma. My initial cancer was successfully removed, but a local recurrence occurred twenty months …

Obesity bias needs to end

David L. Katz, MD

Physician

May 18, 2013

I have witnessed a lot of obesity bias in my career, and I have railed against it on more than one occasion. But it’s not the focus of my career, as it is for some of my colleagues. I have long thought those colleagues who do devote themselves to the topic may tend to overlook a very fundamental question, namely: Why would obesity bias even exist? What rational basis is …

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Obesity bias needs to end

A hidden way to measure quality when finding a doctor

Oliver Kharraz, MD

Physician

May 18, 2013

Choosing a new doctor is never easy. You need to know about convenience factors, such as office location, available appointment times, and accepted insurance plans. You will probably also consider background information, such as education, board certifications, and licenses. But the most important question you likely have involves results: Is this doctor any good?

Unfortunately, there just isn’t a single, perfect way to measure the quality of individual …

Being a caregiver has made me a better doctor

Scott Finkelstein, MD

Physician

May 17, 2013

I am a physician, an anesthesiologist. I care for the sickest of the sick every day – struggling NICU babies born only hours earlier, victims of major traumatic accidents, and critically ill patients with life threatening illness. In this job, I must both connect with the patient, but also maintain a distance from them at the same time. Dealing with life threatening …

Stories surround every physician

Bruce Campbell, MD

Physician

May 17, 2013

Could a greater miracle take place than for us to look through each other’s eyes for an instant?
-Henry David Thoreau

It is almost 7:00am I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun.

I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today …

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Stories surround every physician

ASA: Doctors and nurses are simply not one and the same

Kenneth Elmassian, DO

Physician

May 16, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Recently, discussion about health care has reached a fever pitch, between changes in policy, adjustments to scope of practice and a multitude of other medical issues. As health care providers, it is our duty to provide the highest level of medical care to all patients to …

When the business of medicine trumps appropriate care

Jordan Grumet, MD

Physician

May 16, 2013

I almost fell off my chair. It was bad enough that he showed up to the ER. But what happened next really blew my mind. He fell and bruised a rib. The pain in his left chest had obvious enough origins. But triage had put in for an electrocardiogram and the interpretation apparently scared the resident. The attending took a look, and shook his head.

“Left bundle branch block. Better call …

What is the role of the physician in today’s health care system?

Hans Duvefelt, MD

Physician

May 15, 2013

I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch.

I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit.

I often questioned why my colleagues’ patients would sometimes end up in …