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.

The movement against obesity threatens many livelihoods

Michael Kirsch, MD

Physician

November 29, 2012

One cannot escape the issue of rising obesity rates in the United States. A current statistic predicts that by the year 2030, 42% of us will be obese. The ramifications of this ponderous eventuality could indeed weigh down and sink the nation. Some of the consequences include:

Zillions of health care dollars spent treating obesity directly.
Gazillions of health care dollars treating medical consequences of obesity.
Loss of economic productivity from a bloated …
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The movement against obesity threatens many livelihoods

How pain control comes from the front and back

Shara Yurkiewicz

Physician

November 29, 2012

She had only been in the hospital twice in her life: once when she was nine and now, 60 years later. She had gotten tonsils out then. She was getting tumors out now.

Her abdomen hurt when she was awake. Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia. Her body would feel it, though, and could respond by dangerously spiking …

It’s amazing what I’ve learned from patients

Janice Boughton, MD

Physician

November 29, 2012

Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …

How Medicare will devalue the work of psychiatrists

Dinah Miller, MD

Physician

November 29, 2012

For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on …

I remembered again what it was like to be a patient

Maria Yang, MD

Physician

November 28, 2012

It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour.

The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop.

“I’ll let the …

Telling someone of a loved one’s death never gets easier

Kevin Dorsey, MD

Physician

November 28, 2012

About thirty years ago, after I’d completed my internal medicine residency and a rheumatology fellowship, my wife and I moved with our three-year-old son to my wife’s hometown.

There I joined a multispecialty group practice as the second rheumatologist. Over time, the plan was for me to build a rheumatology practice, but while that was happening I took on all kinds of patients, both primary-care and intensive-care. I felt very comfortable …

Prognosis near the end of life: We need better tools

Robert Wachter, MD

Physician

November 28, 2012

The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and Martin Luther King’s famous speech might have been entitled, “I Have a Strategic Plan and …

A physician takes his flu vaccine under protest

Doug McGuff, MD

Physician

November 27, 2012

To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family. Unfortunately, I do not qualify for any of the exemptions allowed by our facility. Since I am not religious, I have …

A rare case when needs of the dying should be secondary

Monica Williams-Murphy, MD

Physician

November 27, 2012

I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over.

Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next …

Income inequality among physicians should matter to patients

Manoj Jain, MD, MPH

Physician

November 27, 2012

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …

Click, click, click: How can I help you today?

Stewart Segal, MD

Physician

November 26, 2012

Click, click, click, “Hello, how are you today?”

Click, click, click, “How long have you had a sore throat?”

Click, click, click, “Have you had a fever?”

Click, click, click, “Have a seat on my exam table, please.”

Click, click, click, welcome to my day. Let me introduce myself, I’m a professional clicker. I used to be a member of a highly respected and sought after profession; a doctor. The modern world of government/insurer …

Mean doctors and nice nurses: It’s time to change our brand

Karen S. Sibert, MD

Physician

November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

I want to be there when that cancer freight train hits

Miranda Fielding, MD

Physician

November 26, 2012

Sometimes, you can see cancer coming. What I mean is that when we sign up for that mammogram, or that PSA blood test, there has to be some tiny little part of us that says, “Ok, this time it’s my turn. This time I’m the one who’s going to get the call.”

Sometimes the cancer sneaks up on us—that nagging little cough that makes us want to—suddenly and belatedly—quit smoking. Or …

Why aren’t more people talking about physician suicide?

Pamela Wible, MD

Physician

November 26, 2012

I live in Eugene — a sweet little community with snow-capped mountains, farmers’ markets and the friendliest people around.

But a few weeks ago, one of our beloved pediatricians shot himself in the head in a public park. Earlier this year, one of our surgeons was found dead in his car from carbon monoxide poisoning.

And just before him, a urologist shot himself in the head in his backyard. Before him, a …

Does the use of digital medicine preclude human connection?

Heather Logghe, MD

Physician

November 26, 2012

In a recent New York Times article, “Redefining Medicine with Apps and iPads,” Katie Hafner describes a “generational divide” in medicine. On one side sits the younger generation, at ease navigating EMRs and diagnosing disease with the assistance if digital apps. On the other side of this presumed generational divide, she describes the older generation, worried “that the human connections that lie at the core of medical practice …

A doctor reflects on the cusp of retirement

David Mokotoff, MD

Physician

November 25, 2012

June 30, 2014. I don’t need to have this date circled on my calendar, or on my phone calendar reminder app. It is now etched in my brain. That is the date of my anticipated retirement from private practice. It is hard enough for me to grasp that next summer I can enroll in Medicare, let alone quit working––something I have done with only one brief 3 month break, since …

Why do we fear old age so much?

Arsheeya Mashaw, MD

Physician

November 25, 2012

A Swedish sociologist Lars Tornstam describes this by asking what a 10 year old would say if we asked him what it would be like to be 20. It would be awful to him. There would be no play time. There would be no summer vacation. He would have to get a job! But at twenty he would look back at the age of 10 and say: “There’s no way …

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Why do we fear old age so much?

Society must come to a conclusion on how important human suffering is

Pinak S. Joshi

Physician

November 23, 2012

The art and practice of medicine is built around lessening the suffering of our fellow man. The method of doing this however, has changed dramatically throughout human history. Western medicine had its beginnings in the restoring balance to the body that was not in sync with the environment. As scientific reasoning found its way into medical practice after the dark ages, the benefits of medicine quickly became a cornerstone of …

A spectrum of medical talent to solve the primary care shortage

Anthony Brenneman, PA-C

Physician

November 23, 2012

We’ve all seen the data projecting a shortage of physicians in the United States, expected to reach a shortfall of more than 90,000 by 2020. The lack of nurses is equally well documented. These trends raise concern for all medical specialties, but especially for primary care.

More and more Americans are expected to need these services in the coming years, at a time when fewer and fewer students are committing to …

How physician executives will drive value for hospitals

Michael N. Sills, MD and James Merritt

Physician

November 22, 2012

“Value” is the pot of gold at the end of the rainbow that health care professionals everywhere are seeking, but which few can seem to find.

Policy makers, hospital executives, physicians, consultants – all are looking for a means to pivot away from a system that rewards volume of services provided to one that rewards quality and cost effectiveness (i.e., “value”).

How far we are from achieving this goal can be gauged …