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.
When the American College of Emergency Physicians (ACEP) decided not to join the Choosing Wisely campaign, I was among those who expressed disappointment with this decision, in part because I have long been a proponent of efforts to encourage more cost-effective care in the ED. In fact I had already independently done a significant amount of work in the development of such strategies.
I recognized that there were legitimate concerns …
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Choosing Wisely: Less dogmatic language is needed
This question was what drove me to graduate school for an MPH degree a few years ago. I was finishing up my family medicine residency at, arguably, one of the top residency programs in the nation. I had been well trained in both medical science and doctor-patient relationship skills. Yet my patients still consistently did not adhere to my advice.
I was not disappointed in my MPH studies. It turns out …
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Why don’t our patients do what we tell them?
Having married parents is good for children. That’s why the American Academy of Pediatrics (AAP) thinks that same-sex couples should be able to marry.
In a policy statement, that’s exactly what they said. It’s going to put the AAP in the middle of controversy–but it was the right thing to do for children.
There are currently almost 2 million children being raised by gay and lesbian parents in the United States. And …
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Same-sex couples should be able to marry: Why the AAP got involved
What does the 21st century physician look like?
I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”
Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.
(As for the 21st century in general, given the speed at …
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The skills that tomorrow’s doctors will need
Next in a continuing series.
Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …
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That slippery bowel wants to be everywhere
As a second year medical student in 1971, I still remember an article in the prestigious New England Journal of Medicine, describing a new phenomenon, The Emperor’s New Clothes Syndrome. It was based upon the famous Danish author, Hans Christian Anderson’s fairly tale from the 1800’s.
A vain emperor, who cares for nothing except wearing and displaying clothes hires two swindlers who promise him the finest, best suit of clothes from …
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Copy and paste medicine is not new
I was sitting in the resident workroom at Massachusetts General Hospital (MGH) when my co-resident showed me the text from her sister: two explosions had shaken the finish line of the Boston marathon. Though news sites had not yet published the headline, it was immediately corroborated by the cacophonic wails of ambulances heading towards us and our shock was quickly replaced by the urge to learn more and to do …
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Being a doctor in a time of crisis
I am old enough to remember when physicians did not advertise. It was considered a professional ethical issue. Hospital advertising consisted of institutional “We’re here” ads. Anything aggressive by docs or hospitals was considered bad taste… but that was before health care became as competitive as any other type of business.
I have been barraged, as have many of you, by a wave of hospital advertisements as our health care marketplaces …
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There is minimal oversight of hospital marketing
Not long ago I noted a certain older patient’s name on my schedule. I really dreaded seeing her. It’s not that I dislike her–in fact she’s one of my favorite patients. It was just that I hated the prospect of seeing her looking as poorly as I knew she would. She’d been through so much: an accident resulting in devastating injuries followed by painful surgeries, and, worst, in the middle …
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After the Boston Marathon: Trauma itself can bring strength
There’s this weird feeling I get when I hear bad news, or even not that bad news, or even the possibility of bad news: a tingling that spreads across my forehead, down my face, into my jaw, and then to my chest, where it settles like a…no, not a lump…a void. I get the feeling every time I go for my annual mammogram or any other medical test, I wonder …
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How would you react to a cancer diagnosis?
A city is free. A town is celebrating.
I sat and watched the local news station announce that the second suspect in the 2013 Boston Marathon bombings had been taken into custody and was being transported to a nearby hospital.
I am relieved. And thankful.
Then I wonder. I wonder about the hospital that this suspect is being transferred to, and I wonder about my colleagues. What are the nurses, the doctors, and …
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Treating the enemy still requires respect and professionalism
It has been weeks since the Boston marathon bombings. The hospitals in that city, by most accounts, were remarkably well prepared, expertly and compassionately caring for the injured innocents. Emergency response was fluid and efficient. As tragic as the events of April 15 were, the health care workers of Boston were beacons of inspiration for a city in shock.
Yet these heroics do not represent the most impressive actions performed by …
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Dzhokhar Tsarnaev and the true cost of upholding the Hippocratic Oath
Hi. I’m a 44-year old emergency physician. And I’m an addict.
My addiction came to light when my Press Ganey scores plummeted after I started to stand up to the chronic pain and frequent ER patients.
The fact that I have an addiction was reaffirmed when I went to my state’s Prescription Drug Abuse Summit. When I saw so many professionals from varying fields (medicine, law enforcement, pharmacy, education) assembled, I realized …
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I’m addicted to prescribing pain medications
Hospitals can save you, but they can also harm you. So how can you stay safe in hospitals? Follow these 12 life-saving tips:
1. Never go alone. Always bring someone else—a trusted family member or friend—with you. That person will be your primary advocate, and can serve as an extra set of eyes and ears to help make sure you are safe. (This tip applies to routine doctors’ appointments too; always …
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12 tips to stay safe in hospitals
I’ve been going about this all wrong.
It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong. It’s the fact that I am doing this without my most important resource: my patients.
I realized this while driving in to work this past week. My first patient was …
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Building a true collaborative health record: Ask your patients
As an intellectual female surgeon, I have always resented being pinned down by my gender. Throughout medical school, I refused to join “Women’s Societies”. I felt that these were excuses for disillusioned women to get together and complain that the reason they were not succeeding was their gender. I, on the other hand, did not feel limited by my gender nor did I hide it. Instead, I relished it. I …
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Lean in: The subtle complexity of having it all in medicine
A front-page Boston Globe article on a neurosurgeon suing a caregiver for a harsh blog post is exciting but unrepresentative of the overall state of online doctor reviews. However it caused me to take another look at online physician ratings from the perspective of someone trying to find a doctor.
Conclusion: we are still in the early days and there is plenty of opportunity for better, more useful information. …
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The state of online doctor ratings: It’s still early
My son has been accepted into medical school, we learned last week, and I must say I’m about as happy a mother and a physician as you could find anywhere. For everything that’s wrong with the American healthcare system today, medicine is a wonderful profession and it’s still the greatest honor in the world for a patient to have faith in your skills and care.
It will be interesting to see …
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My hope for the upcoming generation of physicians
In 2010, a surgical scrub technician named Kristen Parker was sentenced to thirty years in federal prison after allegedly diverting fentanyl from operating rooms, injecting herself with the powerful intravenous narcotic, refilling the contaminated syringes with saline, and replacing them to be used on patients. She was infected with hepatitis C, and her drug diversions infected over two dozen patients in the Denver area.
In 2012, David Kwiatkowski, also positive for …
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Can physicians really stop the actions of reckless caregivers?
