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.
When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …
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What does patient centered care say about psychiatry as a science?
June in the United States heralds the month when residencies end and new ones begin. While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations. I had the pleasure of doing so recently.
Excitement. With all of the dreary news of …
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Why doctors should attend residency graduations
I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country.
The problem is that it’s too expensive and often isn’t very good, but that’s clear.
The reason medical care in this country is fragmented and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly …
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Most medical students don’t have what it takes for primary care
One of the big practice challenges most physicians face is a frustrating gap in our leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients.
This new leadership role can be daunting. We are prepared to diagnose and treat, but what about all the other questions that come our way? At times It …
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The frustrating gap of physician leadership skills
For years, I have been telling families in my practice, especially those with teens, to eat dinner together. Family dinners make a difference, I tell them. Studies show that they not only help prevent obesity, they help kids do better in school and help keep them out of trouble.
Now a study says that’s a bunch of hogwash.
Well, not exactly hogwash. The researchers from Cornell who wrote “Assessing Causality and …
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Don’t give up on the family dinner
The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:
“The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about …
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Marcus Welby, MD is still relevant today
Does your doctor have something on the wall that starts with “American Board of … “?
The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.
The first thing to understand is that anybody who has graduated from …
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Does it matter if your doctor is board certified or board eligible?
Recently our department of medicine grand rounds was on the subject of asthma. It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades. The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part.
As someone who works in an academic hospital, I know many physician-scientists. …
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Clinician researchers meet the physician scientists
What do you think is the physician-view of an “ideal patient”?
Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can’t believe that we will be so lucky. …
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Should doctors really want ideal patients?
Does it really make sense for a neurosurgeon to be quoted in a news story about a new treatment for diabetes or prevention of obesity? Some news reporters think so, leaving primary care physicians frustrated at the media’s lack of understanding about the wide range of expertise they practice on a daily basis. In both news and entertainment media, seeking out and representing primary care expertise seems to be the …
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Primary care physicians are negatively portrayed in the media
“Great interview, darling, but there’s one question you didn’t quite answer.”
My wife is my best coach. She thought the question about a busy orthopedic surgeon not having time to relate to his patients deserved a better response.
My interviewer, a psychiatrist, said he once accompanied a surgeon friend on his Saturday morning round of post-op cases. On the drive home, he challenged his friend with the observation that many of the …
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The secrets to a fulfilling medical practice are often paradoxical
I was recently asked to speak at hematology-oncology Grand Rounds at Rhode Island Hospital. Instead of my usual topics on gynecologic cancers or sexual health, my colleague, MaryAnn Fenton, had asked me to speak to them about promotion in academics. I was both touched and taken aback that I was now in a position to give that kind of advice. …
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Always remember why you are a doctor
“Cheers!” “To good health,” my girlfriend and I toasted in the living room of our apartment joined by my parents on speakerphone.
It had been 12 years since my last radiation treatment—my last treatment for Hodgkin’s Lymphoma. Tonight was the anniversary of my remission, and in the case of Hodgkin’s—a cancer with an exceedingly low relapse rate—tonight was my anniversary of being cured.
I kissed my girlfriend goodbye and tread the dark …
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Long waits to access primary care are avoidable
Pretty much everyone chats up shared decision making these days. And that is good. It seems intuitive that people (patients) who are knowledgeable about their condition and buy in and/or help to shape the treatment plan are more likely to follow it.
Here is an example from my seatmate on today’s flight from SFO to our nation’s capitol. Her son, let’s call him Alex, is a teen with cystic fibrosis (CF). …
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Why isn’t shared decision making standard practice?
It’s been two days now since I basked in the glory. I still find myself floating above the ground. I can still feel the weight of the heavy gown and the velvet tam. I can feel the tickle of the tassel on my ear. My eyes fill with tears at the thought of my classmates – those who toiled alongside me – experiencing the same emotions. The reminders of our …
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The selfless people in medicine are the people a patient never sees
While reading the New York Times I stumbled upon an article by Pauline Chen addressing issues with doctor patient communication.
In the article, Dr. Chen describes a highly educated, articulate patient who was unwilling to speak up and discuss care related issues with her doctor. The reasons given for not wanting to speak up included not wanting to anger the physician and not giving the perception of questioning judgement.
I immediately began …
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Patients must speak up at the doctor’s office
Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness …
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Finding the right model for patient satisfaction
