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.
One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication.
Design a standardized form for all medical reporting.
Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with …
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Design a standardized form for all medical reporting
Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …
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Take the time to educate yourself before forming an opinion
“Everything must change, nothing stays the same. Everyone will change, no one stays the same.”
Technology is amazing. I love to download random songs on my iPhone and listen to the songs that populate. On one bright early morning, Oleta Adams came on. The song was “Everything must change.” It’s a beautiful and haunting, somewhat sad but at the same time hopeful, song. It stirred up memories, and I found myself …
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Patients and doctors remain connected, even though distance
I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians. The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients. She bemoaned that she was abandoned — her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My …
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Doctors see little of the money patients pay towards health insurance
I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical …
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5 questions to change your end-of-life path
Local hospital readmission data mirror national data in that twenty percent of hospitalized patients are readmitted within 12 days of discharge, and 30% within 30 days. Hospital reimbursement has changed to global, not fee for service payment. Hospitals and physicians need to create effective ways to prevent readmission. Readmissions also portend poorer outcomes. Therefore, it is our task as the physician community, to work collaboratively in this process.
Currently, most patients …
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Why reducing readmission rates is so difficult
“There are three kinds of men. The ones that learn by reading. The few who learn by observation. The rest of them have to pee on the electric fence for themselves.”
– Will Rogers
Learning is a universal human experience from the moment we take our first breath. It is never finished until the last breath is given up. With a lifetime of learning, eventually we should get it right.
But we don’t. …
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Sometimes both physicians and patients learn the hard way
We’ve come to a sorry pass in American medicine when physicians are willing to spend a lot of money to attend conferences—not to learn how to become better physicians, but to find a way out of the pit of clinical practice.
Few of us have the charisma (or chutzpah) to make a living in medical show business, like Sanjay Gupta or Mehmet Oz. But apparently any physician today can be clever …
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Is not seeing patients the answer for many doctors?
I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients). The case on first glance didn’t look very good for this defendant. The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and …
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The problem of expert witnesses in medical malpractice trials
An excerpt from Behind the Mask.
Why do you do it?
Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter of …
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Why I am a surgeon
Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask. There is nothing specific …
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Ask your doctor smart health questions
“I will never forget that day.”
She smiled broadly.
“It was about a week after my cancer surgery and I had finally worked up the courage to look in the mirror. I knew you had rearranged things a bit, okay. Moved stuff around. Taken things apart and jammed them all back together, right?”
I probably would not have said it quite like that, but she was correct that her surgery had involved removing part of her …
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Imagining what goes through a patient’s mind after surgery
“I want you to get me a new doctor,” she told me, a bit of disgust coming out in the sharp tone in her voice.
“What happened?” I asked.
“He asked me if I was nauseated, and I told him no, I was just vomiting. Then he asked if I was feeling pain in my stomach, and again I told him no, it was just vomiting. He then told his nurse to …
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Playing specialist roulette every time I send people to another doctor
My mom always told me she gave me the “doctor name” (apparently my name looks good with an MD after it), so in some ways I knew from an early age that this was going to be my profession. Though I toyed with the idea of being a bank teller in kindergarten, I realized after a while that this was really not the job I thought it was (no offense …
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Why I chose to become a rural primary care doctor
Recently, I listened with interest to an interview on NPR that posed the question of who needs long-term-care (LTC) insurance. Only one percent of Americans own LTC insurance which defrays the cost of custodial care.
Because of recent experiences I’ve had with my mother, I’ve have been thinking about how I’d like to spend the rest of my life when or if (I admit to fits of denial) the time comes …
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Think about the eventuality that comes to ourselves and our parents
Once upon a time people only went to the doctor when they felt sick. For most of human existence there was not much the doctor could actually do when you got there. Yet somehow the human race managed to get through to the second half of the twentieth century when things changed completely.
As technology advanced exponentially we developed a range of treatments so that conditions, which used to be fatal …
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We are overdosing on medical tests
Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a …
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Contaminating medicine with mercenary incentives
Today would have been easier if I did not give a damn. Easier if patients were clients. Easier if medical advice was causal suggestion. Easier if I believed that patients were solely responsible for their health. Easier if suffering was not real. Much easier, if I did not care.
However, despite the popular movement from “the doctor knows best” towards shared decision-making, I feel responsible for my patients. What happens to …
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When patients make the decisions to harm themselves
