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.

I tried to find peace in the loneliness that comes after a death

Sarah E. Stumbar, MD

Physician

March 1, 2013

You might be surprised to know that I’m lying here in bed still thinking of you two weeks after you’ve died.

During the month that I watched you die, I often wondered what it felt like to be you, with your deep, husky voice, rounded belly and stubborn anger. You’d once owned your own mechanic shop; now you were sitting here in a hospital bed, staring up at the medical team …

It is time for us to succeed by being the best that we can be

Jeffrey Hall Dobken, MD, MPH

Physician

March 1, 2013

LanceArmstrongOprahinterview

According to George Orwell, “serious sport has nothing to do with fair play. It is bound up with hatred, with jealousy, with boastfulness, with disregard for all rules, and with sadistic pleasure in witnessing violence: in other words it is war minus the shooting.”

Ok … sounds pretty much like the Super Bowl, but the Tour de France? Lance Armstrong? Ergogenic aids? Cancer …

Sending your child to the chiropractor: Be very careful

Roy Benaroch, MD

Physician

February 28, 2013

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There are plenty of things we don’t know about health and illness. Sure, we know a lot more than we did fifty or a hundred years ago—but every day, still, I have questions that aren’t yet answered. I read a dozen or so journals each month. (I know. Nerd.) Each one has at least ten or so good quality studies—good, …

What happens if the doctor isn’t sure?

Leana Wen, MD

Physician

February 28, 2013

An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

One Friday, Jerry got the scare of his life.

Jerry is a 48-year old mechanic who is in good health. His parents are healthy, and he recently got a “clean bill …

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What happens if the doctor isn’t sure?

This is what it’s like to do an operation

Sid Schwab, MD

Physician

February 28, 2013

First in a continuing series.

With as much detail as is useful, and as descriptively as I can manage, I’d like to relate what it’s like to do an operation, from before laying knife on skin to after placing the bandage. I’m a general surgeon, so I choose sigmoid colectomy as my prototype; it’s always been one of my favorites, although the particular …

Do most patients with cancer receive proper prescriptions for pain?

James C. Salwitz, MD

Physician

February 28, 2013

To state the obvious: 1) most advanced cancer patients have pain, and 2) we have excellent pain medications which can effectively treat more than 90% of cancer pain. Therefore, most patients with cancer receive proper prescriptions for pain. Obvious, yes? True? No.

In Europe, Australia and North America narcotic analgesics are widely available, and frequently prescribed. While there is access, many patients, particularly those in certain groups such as seniors and …

The solo family doc isn’t extinct: I’m proof of that

Pamela Wible, MD

Physician

February 27, 2013

An excerpt from Pet Goats and Pap Smears.

My dad is eighty-eight years old. He finally retired from medicine at eighty-six. I call to check on him. “What are you up to, Dad?”

“I just returned from synagogue a few hours ago. Right now I’m catching up on my reading. I’m finishing up the fiftieth anniversary issue of Medical Economics.

That’s Dad living it up on a Saturday night.

“It …

What doctors and Abraham Lincoln have in common

Christopher Johnson, MD

Physician

February 27, 2013

I have a colleague who has lost his capacity to continue practicing pediatric critical care medicine. It didn’t happen suddenly; it came on gradually over a year or so. It also didn’t follow from a single event or bad experience. It was just a creeping uneasiness that culminated in his unwillingness, after two decades, to go on doing this. Even though I’ve been practicing pediatric critical care for thirty years, …

Doctors don’t get investigated for being quacks

PalMD

Physician

February 27, 2013

A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write …

Destroying the family physician: An AAFP member responds

LaDona Schmidt, MD

Physician

February 27, 2013

A response to The creative destruction of the American family physician.

Dr. Brooks’ column shines a bright light on the misconception that some subspecialists have about the core of primary medical care and family medicine. As a former nurse practitioner and current family physician, I’d like to point out the flaws of his argument.

At a time when the health care community is working to end the fragmentation, duplication and gross …

The reality of illness at work and the reality of wellness at home

Miriam Stewart, MD

Physician

February 26, 2013

I was changing my daughter’s diaper the other night when I noticed some spots. There was a cluster of six or so around her belly button and a line of them tracing her bottom rib on the right. They were reddish-brownish-purple pinpoints and when I pressed on them, they did not blanch. She did not seem bothered by them at all. I, on the other hand, began to quietly freak …

Operating on myself: What could possibly go wrong?

bongi, MD

Physician

February 26, 2013

As I have mentioned before, all surgeons think they are the best. Of course when we ourselves need surgery, there is a bit of a dilemma deciding who is the best qualified to carry out the procedure. So when I realized there was a strange looking skin lesion in my right inner thigh, I decided only the best would do to operate me.

In my rooms I informed the sister I …

Minimize the tragedy of gun violence

Daniel Ginsberg, MD

Physician

February 26, 2013

There is an epidemic of gun violence. This is a serious health problem. Watching your diet, exercising, and taking pills is all for naught if a bullet kills you.

In Newtown, Conn., one of the worst mass shooting occurred last week when a gunman shot his mother at home, apparently with her own gun, then walked into an elementary school and shot six other adults and 20 children, before shooting himself. …

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Minimize the tragedy of gun violence

We need an evidence-based, randomized trial on gun control

Ryan Madanick, MD

Physician

February 25, 2013

For just a moment, let’s take a scientific viewpoint about gun control here and try to leave emotions (and the Constitutional argument) out.

The best type of study to determine whether gun control and/or regulation would be a randomized trial: randomizing a state or country to regulation or not.

Since that’s not going to happen, the next best type of evidence we have to go by is observational, either case-control or cohort …

Smoking has become hidden in the shadow of obesity

Ishani Ganguli, MD

Physician

February 25, 2013

I knew he was sick when he told me he’d thrown out his cigarettes on account of how badly he felt.

Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him everywhere. What else could he expect after smoking three packs a day since he was six years old? But he had shown …

Imagine a doctor actually trying to save money for his patients

Rob Lamberts, MD

Physician

February 25, 2013

It has always been my assumption that my new practice will be as “digital” as possible. No, I am not going into urology, I am talking about computers.

[Waiting for the chuckles to subside]

For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s …

Physicians: Improve the experience of communication

Don S. Dizon, MD

Physician

February 25, 2013

One of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is.

I was …

Pathologists face a stark career choice

George Lundberg, MD

Physician

February 23, 2013

Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology.

Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then?

Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science.

Molecular testing of the actual cancer tissue …

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Pathologists face a stark career choice

Raising a child alone in a culture of quick fixes

Claudia M. Gold, MD

Physician

February 22, 2013

Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight — or was it distress; it was hard to tell — he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” …

Why the American problem with opioids and chronic pain is here to stay

Jennifer Gunter, MD

Physician

February 22, 2013

America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you.

To combat our opioidification the Read more…

Why the American problem with opioids and chronic pain is here to stay