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.

Physicians are often expected to prove a negative

WhiteCoat, MD

Physician

May 8, 2013

A young lady comes to the emergency department and wants to be evaluated for a somewhat non-urgent problem.

Chief complaint: “I’ve lost 50 lbs in the past month.”

She felt a little weak as well, but she had just lost too much weight. No other symptoms.

The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed …

A radiologist reflects on indeterminate findings

Paul Dorio, MD

Physician

May 7, 2013

shutterstock_107615549

Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.

Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …

Independent nurse practitioners are not the primary care solution

Reid Blackwelder, MD

Physician

May 7, 2013

In her post, “The only thing that truly separates doctors from nurses,” Dr. Leng is right that our current system creates a great deal of confusion for patients. Clothing, titles and even the word “Doctor” are no longer clear enough for people to understand which member of the health care team is caring for them. However, her suggestion that ultimate responsibility for the patient is the only distinguishing feature …

As I sit by my father in the hospital, there is a choice to be made

Miranda Fielding, MD

Physician

May 6, 2013

With gratitude to Doctors Rafael Espada and Michael Madani, for fixing my father’s heart, twice.

When Michael Phelps was interviewed during the Beijing Olympics, the world first learned about the extraordinary amount of food needed to fuel the swimmer with the wingspan of a pterodactyl. He said that he ate 12,000 calories a day, and no one believed him except for me. I believed him because I too was a swimmer …

Should primary care limit its scope of work?

Joshua Freeman, MD

Physician

May 6, 2013

The shortage of primary care physicians in the U.S. has become a national theme. A common proposed solution to this shortage – and a central component of the patient centered medical home – is team-based care that utilizes various non-physician health care professionals as well as electronic communication. The idea is that many functions carried out by physicians can be done by nurse practitioners, physician assistants, nurses, and others on …

Female feticide: The ethical issues of ultrasound in India and China

Janice Boughton, MD

Physician

May 6, 2013

shutterstock_124682011

The use of ultrasound has had a large impact on health care in resource poor countries. This article details some of the research that has been done overseas to look at the impact on bedside ultrasound by caregivers to deliver more appropriate care for injured and ill patients in Africa, Asia and Mexico.

Using an ultrasound to determine how dehydrated a child …

Is there still sexism in medicine?

Suzanne Koven, MD

Physician

May 6, 2013

When I was growing up in the 1960s, at the height of the Cold War, there was always some smart aleck boy on the playground who had “facts” to share about the Soviets. His recitation was meant to emphasize how weird, how different, how other our arch enemies were. “They make you wear all brown and gray there.” “They eat only boiled cabbage and potatoes.” “They tell you what to …

Read more…

Is there still sexism in medicine?

Ordering tests just to reassure patients doesn’t work

Albert Fuchs, MD

Physician

May 5, 2013

Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren’t even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that …

How to know if a medical mission is right for you

Olabisi Jagun, MD

Physician

May 5, 2013

I have found that many physicians have a strong desire to serve, yet often don’t know where to begin or if it is the right move for them both personally and professionally. I believe that by answering a few simple questions, a physician can decide if a mission is right for them.

1. Decide where you want to help. Hailing from Africa, I wanted to return to the poorest regions such as …

When it comes to handling cases, good communication helps

Gizabeth Shyder, MD

Physician

May 5, 2013

I saw a thoracic surgeon in the doctor’s lounge today. I have read his cases and frozens for a year or so, but never introduced myself. I still get intimidated in that man’s world of the doctor’s lounge. It’s not just me, my female partner was urged by her male recruiter to eat with him every morning in the lounge when she started seven years ago, and chit chat with …

Dzhokhar Tsarnaev and his right to privacy

Shirie Leng, MD

Physician

May 4, 2013

I am affiliated with the institution where Dzhokhar Tsarnaev is currently hospitalized. I am friends with people who have treated him. I’m trying to stay away from those people; I would be unable to help asking them about him. They might be unable to help talking about him.

There has been a flurry of emails and red-letter warnings cautioning people here not to talk about Mr. Tsarnaev or look him up …

Why are emergency physicians burning out?

Michelle Finkel, MD

Physician

May 4, 2013

Emergency physicians experience burnout at a rate of more than three times that of the average doctor and more than anyone else inside or outside of the medical field, according to a study published in the Archives of Internal Medicine. The study surveyed over 7000 physicians in more than two dozen specialties and compared them with almost 3500 working adults …

Is a board certified surgeon a safer one?

Chris Porter, MD

Physician

May 3, 2013

Am I safe surgeon, or merely a board certified one?

I usually spend Tuesdays fixing elective hernias. But the other day I was asked to clear a c-spine, handle an unexpected gynecologic finding, manage a pediatric trauma, resuscitate a septic ICU patient, and opine on a neck dissection. No, I wasn’t in Africa or 1985; I was sitting in front of a computer …

After the Boston Marathon, a reflection on New York

Don S. Dizon, MD

Physician

May 3, 2013

On April 15, 2013, my kids and I were in Stamford, CT, visiting with my sister, Precy, and her family. I had been reading when an email came up, stating a bomb had gone off at the Boston Marathon. I immediately turned to Twitter where #BostonMarathon had already started trending.

There before me, gruesome details emerged, coupled with …

This is what patient engagement really is

Rob Lamberts, MD

Physician

May 2, 2013

“Patient engagement.”

What is patient engagement? It sounds like a season of The Bachelor where a doctor dates hot patients. It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks. There was a even an entire day at the recent HIMSS conference dedicated to patient engagement. I think the next season of The Bachelor should feature a wonk at HIMSS …

Would an ad influence your decision to go to the ER?

Ishani Ganguli, MD

Physician

May 1, 2013

You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the emergency department (ED)? What if that headache comes with a cough and shaking chills?

Would an ad influence your decision?

I came across this image …

Medical residents expect the data to be fed to them

Wes Fisher, MD

Physician

May 1, 2013

“What’s the most important finding on this chest x-ray?”

There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen.

“Um, the pleural effusion?” whimpered a third-year resident.

“No!” barked the attending.

The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently.

“Come on, folks! Look!”

And try as they may, no one saw it.

“The name, folks, …

If only the patient had an advocate

Jordan Grumet, MD

Physician

May 1, 2013

It had all been so easy when Jim was still around. Lisa’s ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa’s father died, and the emotional and physical stress brought the unstable union …

Read more…

If only the patient had an advocate

Prevention isn’t about saving money: It’s about saving lives

David L. Katz, MD

Physician

May 1, 2013

Since an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a “say what?” dangling from your lip, we are on the same page. Let’s populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as “prevention” really makes sense.

The problem of basing physician pay on quality indicators

Skeptical Scalpel, MD

Physician

May 1, 2013

New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators.

The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients …