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.

More than half of my ER shift was spent on entering data

WhiteCoat, MD

Physician

November 21, 2012

I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR systems. In the previous post, I was using the EMPOWER charting system, which I liked for its simplicity, but disliked because of the layouts of the charting interface and some of the macros it contained.

After …

Cancer makes you realize the gift of time

Don S. Dizon, MD

Physician

November 21, 2012

When I was 16 my dad had a heart attack. I still recall studying in my room when my mom came in to tell me he wasn’t feeling well. At the time, I was a volunteer in the emergency room at our local hospital, located in the tiny Pacific Island of Guam. I recall asking him what he was experiencing: …

Repeated story syndrome: Finding the right balance for patients

Ishani Ganguli, MD

Physician

November 21, 2012

The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well …

If pilots worked like doctors, the sky would rain planes

PalMD

Physician

November 20, 2012

“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.”

Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record?

A lot of them. Dictations are easy to read if you are willing to confound legibility and accuracy. Dictation software is relatively cheap, and with the continued profusion …

Why there’s still value in the routine physical

John Mandrola, MD

Physician

November 20, 2012

Millions of Americans believe in the practice.

Government reformers believe in it.

Doctors too.

Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted my own doc, and I wanted yearly “checkups.”

No procedure—not even AF ablation–is as good as prevention. Taking your body in for routine checks and scheduled maintenance makes perfect sense. Call such a notion–obvious.

But …

Why are we still failing patients despite open communication?

Linda Brodsky, MD

Physician

November 20, 2012

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.

I have never paid much attention to these tests. The nurses …

The new standard of an exceptional physician

Wes Fisher, MD

Physician

November 20, 2012

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.

So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more. Doctors lives are spent staring at these damn screens now. I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central …

Cancer survivors are truly remarkable people

J. Leonard Lichtenfeld, MD

Physician

November 19, 2012

David Sampson, who is a colleague of mine here at the American Cancer Society, recently sent me a blog written by a woman well known in the breast cancer community who days previously had been diagnosed with recurrence of her breast cancer. The blog has captivated me, perhaps more so now that I have been facing some of my own …

Why I hate the SOAP note

Suzanne Koven, MD

Physician

November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

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Why I hate the SOAP note

In defense of the terrible twos

Heidi Roman, MD

Physician

November 19, 2012

People often ask how old my son is when we are out and about. When he proudly says, “Two!”, the most common response is a smile to him … and a knowing glance to me. This is often accompanied by, “Oooh, the terrible twos!”

I’m here today to stand in the defense of two-year-olds. Sure, they have their share of tantrums and the transition from infant to preschooler is sometimes a …

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In defense of the terrible twos

Good decision making often depends on good communication

Peter Ubel, MD

Physician

November 19, 2012

We live in an age of patient empowerment. Medical students are now routinely taught that the “right choice” often depends on patient preferences—on how an individual patient weighs the pros and cons of her treatment alternatives. That means medical decisions depend, more than ever, on good communication. Physicians need to help patients understand their choices so that they can partner with their patients in discovering the best alternatives, ones personalized …

5 steps to establish a partnership for shared diagnosis

Leana Wen, MD

Physician

November 18, 2012

In a recent post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care.

Here …

Love: A word that medicine fears

Kirsten Meisinger, MD

Physician

November 18, 2012

Mom, what is the one thing you can’t live without?” My six-year-old son asked me out of nowhere one day.

Air? Water? It was a more interesting riddle than usual.

“Love.” He said proudly, not waiting for me to answer.

Wow. He’s right. Love. But if it is the one thing you can’t live without, why are we so afraid of it in medicine – a field that sustains life?

Doctors seldom use the word …

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Love: A word that medicine fears

Care on the continuum far surpasses the episodic approach

Rob Lamberts, MD

Physician

November 18, 2012

My change from a traditional practice to direct-care has caused me to challenge some of the basic assumptions of the care I’ve given up to this point. Certainly, the nature of my documentation will radically change with my freedom from the tyranny of E/M coding requirements.

Perhaps the biggest change in my care comes courtesy of the way I get paid. The traditional way to be paid is for service rendered (either at …

Know the risk factors for teen motor vehicle crashes

Claire McCarthy, MD

Physician

November 16, 2012

There was some good news recently about teens and driving: according to the Centers for Disease Control (CDC), the number of teens who report drinking and driving has come down by half in the past decade from two in ten to one in ten.

While that really is good–great–news, it doesn’t change the fact that motor vehicle crashes are the leading cause of death for US teens. In 2010, every day …

Do patients bond best with doctors who misinform them with optimism?

Albert Fuchs, MD

Physician

November 16, 2012

Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.

Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some …

Physicians need to be more cost aware

Lauren Demosthenes, MD

Physician

November 15, 2012

I had lunch with my old college roommate last week. She’s a new grandmother and was telling me about her daughter who lives in another state. Her daughter is self pay because she and her husband own a restaurant and have opted out of insurance due to the cost. She received her hospital bill in the mail and she was surprised at the cost of some of the items. As …

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Physicians need to be more cost aware

Apple has introduced me to the uncertainty of being doctored

Rena Xu

Physician

November 15, 2012

On a recent Saturday morning, I took my problems to a bar. The bar was on Boston’s Boylston Street at the end of a row of pubs. Years ago, during orientation week of medical school, my classmates and I had worked our way methodically down that row.

The bar I headed to on this particular day was the Apple Store Genius Bar. The “bouncer,” a man with skinny arms and a …

Improve patient service: Keep your phones open during lunch hour

Neil Baum, MD

Physician

November 15, 2012

I have watched more offices over the past few years close their phones and front desk during the lunch hour. If you close your office for an hour at lunchtime, what message are you sending your patients? You are declaring that serving your patients takes a back seat to serving yourself and your employees. Closing your phone lines at lunchtime means that you are creating missed opportunities for a vital …

Inappropriate care requests: The role of health care professionals

Yul Ejnes, MD

Physician

November 15, 2012

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

How to reduce the cost of medical care while improving quality is the focus of several initiatives, including the American College of Physicians’ High Value Care initiative, the ABIM Foundation’s Choosing Wisely campaign, and Consumer Reports’ Consumer Health Choices.

The common message is that we …

Physician

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