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.
Moving from paper death certificates to an online process called the Washington State Electronic Death Registry System, or EDRS. Sounds like a simple 21st century process that should make the process of completing a death certificate faster and easier right? Oh, the government designed the system. Oops.
I’ve been so frustrated by the unintended consequences of a new state governmental process for completing death certificates.
Beginning in early 2012 Washington state started …
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Moving death certificates to the digital age: Unintended consequences
We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.
There are many things that go into the equation …
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There is no right way to help infants sleep through the night
Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships. I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.
For some, this transition will be more hassle than anything. Some people …
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Why I made the change to direct care practice
I vividly remember the first day my medical school classmates and I met our cadavers in the anatomy lab. Large body bags lay on metal tables that had been bolted to the floor. I remember the sheer size of the bags best. No doubt existed in my mind that dead human bodies indeed lay within them. And yet part of me couldn’t quite grasp that I was actually going to …
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Strive to maintain our compassion for others
Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.
I learned about Scott while reading Jon Ronson’s …
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Help your doctor understand where you’re coming from
There are times when it is necessary to step up to the plate and go the extra mile on behalf of your patients. There is no job description for doing this and there is no manual that gives you instructions on what action you need to take on behalf of your patients. However, when you have the opportunity to do the right thing, at the right time and for the …
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When you do the right thing, you become a better doctor
It’s natural: when you see someone doing something you long to do, you automatically search for reasons to justify why they’re doing it and you’re not. Maybe they had encouraging supportive parents and yours belittled you. Maybe they got their start at a younger age and it’s probably too late for you now. Maybe they got a great education, or were blessed with more opportunities in life.
My coaching clients won’t …
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Give life a chance to amaze you with what’s possible
The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages …
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Healthier menus without restrictive legislation
She was in her late thirties when her medical oncologist asked me to see her. Five years before, one of our community surgeons had removed part of her colon for cancer. She also had a recognized, single metastatic tumor in her liver at the time of that original surgery.
The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance …
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From surgeon to management: Was my decision selfish?
A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases.
The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients.
Sir William Osler wrote: …
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Rural medicine is the most stimulating kind of primary care
When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.
But instead, there …
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Oral board exams: A window into how you behave in the operating room
I’ve written about trying to communicate acuity to families. Maybe that needs to be expanded to encompass the same to other physicians.
To be fair I’m sure some of this, perhaps much of it, rests solely on my shoulders. Recognizing that I’m still going to make an accusation that talking life and death with families and patients is a skill not fostered in many providers. More accurately for this anecdote, and …
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A physician removed from the reality of acute care
It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?
In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …
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Why doctors shouldn’t treat their family and friends
Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …
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Why doctors don’t like to go to doctors
Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.
I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …
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Is customer satisfaction in healthcare a gateway to corruption?
After 18 years in private practice, many good, some not, I am making a very big change. I am leaving my practice.
No, this isn’t my ironic way of saying that I am going to change the way I see my practice; I am really quitting my job. The stresses and pressures of our current health care system become heavier, and heavier, making it increasingly difficult to practice medicine in a way …
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Frustrations with the health care system drove me to a big change
All parents have heard their kids complain that but for 1 or 2 percentage points, they would have achieved a higher grade.
“This is so unfair! My average is 89.9999 and he is still giving me a B+!”
Every kid should receive an A, of course, since psychologists are now professing that every kid is a prodigy in some new measure of intelligence. Academic intelligence, the conventional and obsolescent notion, has been …
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Are medical device companies being demonized?
Atul Gawande, MD is a brilliant writer, no-doubt an excellent surgeon, and many would say a physician-visionary for all that ails America’s health care system. He speaks first-hand of the changes that have occurred in American health care and recently offered his perspective for fixing our health care system to the fertile minds of Harvard’s recent graduating class of 2011.
In his graduation speech, published front and center (yet …
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Defending the American cowboy in medicine
My husband and I had a family practice in Arcata, California, for 28 years, during which time we learned the importance of addressing the patient’s context outside of the medical visit in order to maximize health and self-efficacy.
We went to great lengths to keep patients out of the ER and hospital. I saw one patient with massive pedal edema twice weekly for months to wrap her legs, since she lived …
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Improve the triple aim by adding a fourth: Provider satisfaction
The Pap smear, in which a clinician gently scrapes and brushes cells from a woman’s cervix (the lower portion of her uterus or womb), swishes them in a bottle of fixative solution, and then sends them to the lab to determine if the cells show pre-cancerous or cancerous changes caused by the sexually transmitted human papilloma virus (HPV), is a pretty simple procedure that takes less than a minute to …
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Should standardization end when the exam room door closes?
