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.

Let’s not get rid of the annual physical

Juliet K. Mavromatis, MD

Physician

July 23, 2012

Recently a physician reporter for the New York Times, Elisabeth Rosenthal, argued in the cover article of the Sunday Review that routine physicals are in many ways pointless, and perhaps even dangerous.

In the article, entitled “Let’s Not Get Physicals,” Dr. Rosenthal goes on to point out that many routine tests performed during physicals — EKG’s, pap smears and blood work, are unnecessary. In my opinion, Dr. Rosenthal’s front page …

Doctors experience trauma to their hearts and stress to their souls

Edwin Leap, MD

Physician

July 23, 2012

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I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote!

To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …

A review of NY Med, and fixing health care’s public image

Roheet Kakaday

Physician

July 22, 2012

The ACA passed and is already in trouble. The Republicans are up in arms, calling the ACA an overreach of a totalitarian governmental regime. The Democrats are defending it, promoting its cost-saving measures as a progressive step forward for America.

To say the rhetoric has heated would be an understatement.

I’m not here to debate politics though. In the run up to the Supreme Court’s ruling on the ACA and the recent aftermath, …

How hot-spotting stops bedbugs and other social ills

Mark Wallace, MD, MPH

Physician

July 21, 2012

Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively.

In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems.

Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care …

Will recommendations from Choosing Wisely ever be followed?

William Sullivan, DO, JD

Physician

July 20, 2012

Choosing Wisely is the new campaign advocated by the ABIM Foundation to help physicians “be better stewards of finite health care resources.” The recommendations in the campaign have been published in Consumer Reports and has been distributed to AARP members.

At first glance, the campaign seems to make sense. Limit unnecessary testing and decrease costs. However, I predict that the Choosing Wisely campaign will also have many less desirable effects. I picked out …

Are doctors obligated to seek knowledge that has no medical benefit?

Michael Slade

Physician

July 20, 2012

The New York Times recently published an article titled “A Life-Death Predictor Adds to a Cancer’s Strain” or, alternatively, “Genetic Test Changes Game in Cancer Prognosis.” The piece is interesting on several levels, but, to me, serves to highlight an increasingly common ethical conundrum: are physicians obligated to seek knowledge that is available but has no possible medical benefit?

Most of us are familiar with the Schrödinger’s cat thought experiment …

What surfing can teach doctors about patient recovery

Kevin R. Campbell, MD

Physician

July 19, 2012

Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing).

However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

Physician

July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

What is the goal of palliative care?

Jeffrey I. Kreisberg, PhD

Physician

July 19, 2012

Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

As we …

Read more…

What is the goal of palliative care?

When patients need to find a new equilibrium

John Schumann, MD

Physician

July 18, 2012

Chico (all identifying information removed) was a patient we cared for in the hospital.

Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis.

From my point of view–an instructor teaching residents and medical students–there were two key questions about Chico:

1. What caused his kidneys to fail?

2. Given his kidney failure was “acute,” was there any chance that it’d be reversible? Could Chico’s kidneys heal to the point where …

Why does fear of litigation turn into preference for action?

Peter Ubel, MD

Physician

July 18, 2012

LeBron James exploded past his defender and raced towards the lane. Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air. LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman.

Offensive foul?

Maybe if it had been the first quarter. But given that this was the last minutes of a tightly fought game, the referees …

What can ACO providers do to increase patient engagement?

Steve Wilkins, MPH

Physician

July 17, 2012

Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act. Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack. The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, …

The problem with transformative technologies in medicine

Rob Lamberts, MD

Physician

July 17, 2012

Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: “Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks.

Take your electrocardiogram on your smartphone and send …

How much does surgery cost? About $147 a minute

Nate Johnson

Physician

July 17, 2012

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.

I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and …

All health care providers are not created equally

Marni Nicholas, MD

Physician

July 14, 2012

I’m a physician. I’m not a “health care provider.” I hate that term.

The insurance companies call me a “provider.” In a sense, it’s true. I provide health care services. However, over the past few years I’ve noticed that the lines between different types of “providers” are getting more and more blurred. Sometimes they’re blurred to the point that patients don’t even know what kind of “provider” they are seeing.

I often have …

The first step to changing the culture in healthcare

Vipan Nikore, MD

Physician

July 12, 2012

“Look left, look right”, our group leader told us. No, I was not learning to cross the street. Rather it was my first day of employee orientation at the IBM Software Lab over a decade ago. I was fortunate that our CEO was Lou Gerstner, arguably one of the greatest CEOs who has ever existed. Gerstner stepped into IBM in the early 1990s when the company was struggling. One of …

The reality of marriage equality and health care

Suzanne Koven, MD

Physician

July 11, 2012

Not long ago I fractured my shoulder and needed surgery. After the operation, my husband of 30 years did all the things a loving spouse would be expected to do: He fluffed my pillows and put toothpaste on my toothbrush (try doing that with one arm!) and overlooked my crankiness.

My husband also helped me in ways so fundamental to our status as a married couple that I barely registered them. …

Psychological factors influence how patients interpret information

Alex Smith, MD

Physician

July 10, 2012

Here is the setup. You’re working in the ICU. You want to communicate a prognosis to the family of a patient who is so ill he cannot make decisions. You sensitively state the facts: the patient has less than a 5% chance of survival. Or perhaps you say “he will definitely not survive.”

The family confers, and decides that they want to focus on keeping him alive as long as possible. …

Women in medicine: A front line perspective

PalMD

Physician

July 9, 2012

Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws …

The cerebral work done by a primary care physician should be valued

Kiran Raj Pandey, MD

Physician

July 9, 2012

Primary care is ever the Cinderella-esque tragedy. Ever so maligned, ever engulfed in misery and never really the belle of the ball like she rightfully deserves to be. There may be reasons galore to this. Not least of which is the way primary care work is perceived in this country.

Let me illustrate.

The primary care attending I work with recounted a story from the early 2000s. As is usually the case with visits …