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.

When doing nothing makes the most sense and is the least risky option

Emily Gibson, MD

Physician

February 14, 2013

Even doctors must become patients eventually, and often challenging patients at that. We know enough to be dangerous but not enough to be in charge. We want to question everything but try not to. We can tend to be catastrophic thinkers because that is how we are trained to be, but fear being alarmists. We want our care providers to actually like us, when we know they inwardly cringe knowing …

Medicine requires doctors to constantly manage probabilities

Robert Fenster, MD

Physician

February 14, 2013

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“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”

Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I …

Is the goal of patient satisfaction to make patients happy?

Mark A. Rudolph, MD

Physician

February 13, 2013

The link to a recent article in Forbes magazine entitled, “Why Rating Your Doctor is Bad for Your Health” keeps showing up in my inbox with the subject, “thought you would find this interesting.” The reason is because I’m responsible for overseeing education and training related to physician communication and patient satisfaction for a large national hospitalist practice.

The article isn’t so much interesting as it is unfortunate. Its premise, …

Mourning the death of my medical practice

Michael Chen, MD

Physician

February 13, 2013

“I did it,” I mumbled to myself.

The numbness overwhelmed my immediate sense of dread throughout my body. I was trembling inside, full of anguish and at the same time, unable to contain my seething anger over an uncontrollable destiny. Just a few minutes ago, I turned off her life support system. The series of beeps had slowed down, pace by pace, like the ritardando in a finale movement of a concerto. …

6 tips for getting your doctor to listen to you

Leana Wen, MD

Physician

February 13, 2013

Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?

Studies show that Read more…

6 tips for getting your doctor to listen to you

ACP: Medicine up in the air inflates patient expectations

Yul Ejnes, MD

Physician

February 13, 2013

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

Medicine is big business. If you don’t believe me, the next time that you travel by plane, pick up the airline magazine in the seat pocket and read the ads. If the advertising is a reflection of the air traveling …

You’re still a doctor, even if you’re not on call

David Gelber, MD

Physician

February 13, 2013

Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.

“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.

Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.

So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …

Behind the exam room door: It will be astonishing to me

Emily Gibson, MD

Physician

February 12, 2013

I have the privilege to work in the medical profession where astonishment and revelation awaits me behind each exam room door.

In a typical clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I must peel through the layers of a person quickly to find the core of truth about who they are and why …

10 reasons why I love Medicare as a physician

Floyd B. Russak, MD

Physician

February 12, 2013

I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:

1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while …

Why doctors should not ask patients about guns: A conservative case

Paul Hsieh, MD

Physician

February 12, 2013

Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics …

Doctors are the canaries in the coal mine of medicine

Dike Drummond, MD

Physician

February 12, 2013

Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.

When there is bad air in the mine, the canary’s sensitive lungs will cause …

Should spiritual beliefs play a role in end of life care?

Jim deMaine, MD

Physician

February 12, 2013

William would come to see me every three months for his COPD (chronic obstructive pulmonary disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her.

On one visit he said, “Doctor deMaine, can I tell you something – and promise you won’t think I’m crazy?”

“Sure.”

“Well, my wife …

The creative destruction of the American family physician

Mitchell Brooks, MD

Physician

February 11, 2013

Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides. Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion.

The …

OpenNotes in geriatrics: 6 awkward concerns

Leslie Kernisan, MD, MPH

Physician

February 11, 2013

I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.)

My first reaction was to be impressed by this bold progressive move.

My next reaction was to …

An epic fail when it comes to mental health

Peter Elias, MD

Physician

February 11, 2013

Sometimes the health care system just does not work.

I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …

Needle exchanges: When the perfect is the enemy of the good

Ishani Ganguli, MD

Physician

February 11, 2013

Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston’s South End. I consult my iPhone one more time to confirm that I’m in the right place and knock on the vehicle’s glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on …

A patient cheats death and changes two lives

Monica Williams-Murphy, MD

Physician

February 10, 2013

Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position …

I didn’t become a doctor to bankrupt my patients

Jordan Grumet, MD

Physician

February 8, 2013

I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!

I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …

When should a physician obtain a palliative care consult?

James C. Salwitz, MD

Physician

February 8, 2013

I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.

There is confusion about the role of the primary doctor, when a patient …

When patients feel trapped by doctors and the medical system

Leana Wen, MD

Physician

February 8, 2013

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

Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this morning, her head hurt …

Physician

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