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.

Patients who are in denial may be doing themselves harm

Miranda Fielding, MD

Physician

April 11, 2013

If you desire healing,
let yourself fall ill
let yourself fall ill.
–Rumi

Yesterday I saw a patient—an 80 year old woman with metastatic cancer involving her bones. She had near complete replacement of her twelfth thoracic vertebra by tumor, and also significant destruction of her fourth and fifth lumbar vertebrae, demonstrated by PET-CT scan and bone scan.

She had so much pain in her legs that it was difficult to walk. In …

Why this doctor is compelled to write

Davis Liu, MD

Physician

April 11, 2013

As a doctor, I am compelled to write because of what I know is occurring with alarming frequency in our country. Americans are skipping needed and recommended care that could save their lives and allow them to live to their fullest. Patients are more distracted, as life is more complicated and busier than ever. Households have both parents working, sometimes two jobs, just to make ends meet. They easily would …

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Why this doctor is compelled to write

A memorable introduction to the family

StorytellERdoc, MD

Physician

April 10, 2013

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …

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A memorable introduction to the family

Successfully starting a direct pay practice: Trickle up economics

Rob Lamberts, MD

Physician

April 10, 2013

It’s been a month since I started my new practice. We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending. The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. My admitted ineptitude at financial complexity has forced me to simplify our …

Quality healthcare isn’t just about clicks and lists

John Mandrola, MD

Physician

April 10, 2013

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart …

When photographs transform relationships with patients

Suzanne Koven, MD

Physician

April 10, 2013

When I entered the exam room I found my patient, a woman in her 80s who’d come in for a routine visit, holding a photograph. “I need to show you something,” she said. Some patients bring me photos at every visit–usually their kids’ or grandkids’ annual school pictures, or smartphone shots of a wedding or christening–but she never had before. I wondered what it might be.

She laid the photo on …

What is each minute of my time is really worth?

Hans Duvefelt, MD

Physician

April 9, 2013

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Countless times during the course of my day, some person, entity or task vies for my time and attention.

“If I could just have a minute of your time” begins a request to also see the spouse of a scheduled patient, a sales pitch from a pharmaceutical “rep” or home oxygen vendor, a phone call from a visiting nurse, a message from a …

Celebrate what makes being a woman in medicine special

Katherine Chretien, MD

Physician

April 9, 2013

Recently, I went straight from the hospital to the Washington DC Convention Center for the AMSA National Convention. I was there to receive the 2013 Women Leaders in Medicine Award, along with 4 other women; part of the award reception was a panel discussion on the significance of women leaders in medicine. We had received some questions to ponder ahead of time that the moderator would ask us, and then …

Doctors and nurse practitioners: We’re failing the reality test

Yul Ejnes, MD

Physician

April 9, 2013

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A guest column by the American College of Physicians, exclusive to KevinMD.com.

Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician …

Should OpenNotes become the standard of care?

Leslie Kernisan, MD, MPH

Physician

April 8, 2013

Iinspired by the VA’s big bold step of going OpenNotes, I wrote a blog post titled OpenNotes in geriatrics: 6 awkward concerns.

It was written in the spirit of just about everything I write: to share the nitty-gritty complexities of what I find myself navigating in geriatrics, to bring attention to medical issues that older adults and PCPs struggle with, and to try to bridge …

How can doctors avoid killing or hurting people in their care?

Janice Boughton, MD

Physician

April 8, 2013

Hospitals are very focused on avoiding harming patients lately. They have been moving in that direction for a long time, but with health care reform legislation, payments are on the line, which makes something that was a very good idea into an imperative.

In the year 2000, the Institute of Medicine, a non-profit organization that monitors various aspects of medical care, reported that 44,000-98,000 people died each year due to medical …

The best doctors teach their patients

James C. Salwitz, MD

Physician

April 8, 2013

The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible. The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree. The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …

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The best doctors teach their patients

The co-location of mental health care services in pediatric practices

Claudia M. Gold, MD

Physician

April 7, 2013

Patricia Wen’s front page story, “Children’s Access to Mental Health Care is Growing,” in which she describes the “co-location” of mental health care services in pediatric practices, brought me back to the summer of 2011 when I attended a meeting of a working group of the Massachusetts Chapter of the American Academy of  Pediatrics (MCAAP.) The task of this working group, a subgroup of the MCAAP task force on …

Why you need a population health management IT system

Rosemarie Nelson

Physician

April 7, 2013

Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses.

The 15 most expensive health conditions account for 44% of total …

Resolving medical liability claims with disclosure, apology and offer

Michael Matray

Physician

April 6, 2013

An apology can be a powerful statement that influences how another responds to a perceived wrong. This can be especially true within the context of a doctor-patient relationship. Yet, most physicians have been conditioned to employ a “deny-and-defend” approach to adverse medical outcomes, avoiding apologies because they believe it could imply an admission of guilt or ultimately initiate a lawsuit.

Apology in medicine is neither new or a fringe concept (currently …

Being sued for malpractice launches a mix of overwhelming emotions

Victor Waters, MD, JD

Physician

April 6, 2013

Just as Sherry Gorman describes in her compelling post, being sued for malpractice can launch a complicated mix of often overwhelming emotions so debilitating that personal and professional lives are never the same.

Since so many physicians are sued at some point during their career—some estimates say as many as 9 out of 10 —becoming educated about the malpractice process …

America is experiencing a crisis of grief

Natasha Deonarain, MD, MBA

Physician

April 6, 2013

Politicians, financial experts, pundits and main street America would love to predict what’s going to happen to America in the next five years. But we don’t have to dust off the Dow Jones or the S&P, or even wonder what the Feds are going to do about Medicare, taxes, the debt ceiling or Afghanistan.

All we have to is understand the five stages of grief first developed by Dr. Elizabeth Kubler-Ross.

Elizabeth …

Blaming others for their health problems helps no one

Jennifer Middleton, MD

Physician

April 5, 2013

I inherited motion sickness from my father’s side of the family. I can’t sit in the back seat of a car for more than 10 minutes without becoming sick. I take meclizine before every plane flight.

I inherited asthma from my mother’s side of the family. Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.

These two maladies of mine have …

Let patients be their own people inside the system of care

Zackary Berger, MD, PhD

Physician

April 5, 2013

The more I try to help people in this field of mine, the more I realize that it doesn’t take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn’t figure and of dubious relevance, who came to our clinic seeking advice about …

The only thing that truly separates doctors from nurses

Shirie Leng, MD

Physician

April 3, 2013

Academic Medicine, a journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor? What is a nurse?” Thirty years ago this would have been an absurd question. Not only would it have been absurd for doctors and nurses, but for patients too. Roles were …

Physician

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