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.
April 15th marked the 100th anniversary of the sinking of the Titanic, yet the mystique surrounding its demise has not faded. When the colossal vessel first collided with the iceberg, eyewitness accounts described an eerie sense of serenity that pervaded the ship. Passenger J.J. Astor even remarked, “We are safer here than in that little boat,” before later drowning.
To prefer drowning over safety strike us as irrational, but this behavior …
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What medicine can learn from the Titanic
On a late afternoon in mid-July I was finishing up my first Sunday on call as a third year medical student. I glanced over the patient list for 4 East, the internal medicine floor I had been assigned to cover. Familiar with patients in their eighties and nineties, I was surprised to see a 22-year-old patient admitted with acute kidney injury.
He was a nice-looking young man in good spirits. Spanish …
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Failure of communication led to an excessive hospital stay
There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.
I remember a particular patient from 20 years ago for a very different …
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Patients are our best teachers
I got into medicine because it is fun, and, of course, to help people. I think most of my colleagues did so as well. I get up every day and I get to go to work and figure out puzzles all day. How cool is that? Sure, it may not always be unwarranted or a bad thing, but testing and more testing can definitely take the fun out of taking …
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A good doctor should rarely be surprised by test results
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the meeting. The topic was healthcare reform and its effect on hospitals and physicians. Included were discussions on patient-centered medical homes, accountable care organizations, bundled payments and physician integration and alignment with hospitals.
The course director made it crystal clear that there will be no place in the future for …
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Why physicians are susceptible to hardball tactics
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career. How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.
Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …
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How we deliver bad news is critical to how families deal with grief
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I thought the patient was dead. He was nearly the same color as the pale sheet covering his thin frame. His cheeks were sunken in and his eyes were gazing upward, in what I sometimes call the “death stare.” Then, surprisingly, he moved his arm upward to push his …
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His father’s suffering had already been too great
I was recently appointed the Assistant Director of the Yale Cancer Center with the portfolio of Diversity/Disparities. While I’m not sure I’m the most qualified for this, it has gotten me thinking a lot about diversity, disparities, and what it means to achieve health equity. Too often, I think, we are plagued by narrow thinking … the impression that our …
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Diversity provides color to the tapestry of human experience
How do you define a “good” doc? I was reading the patient responses to an article here on KevinMD.com and was saddened by how many of the patients were angry with their docs. Anger is an unhealthy emotion! One of the respondents was particularly angry about the “unnecessary” tests her doc performed on her and her family.
I have written about the vagaries of the term “unnecessary” in the past. What …
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Necessary is a word best defined when looking back in time
The end of my residency and beginning of my practice was the most wrenching experience of my life. I was woefully prepared for the transition. Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes. Things have changed considerably, but the psychological passage I endured still holds.
I think my process of becoming a surgeon was fairly typical, with the exception that there was no one …
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Medical school and residency aren’t places for human growth
I believe the greatest challenge in medicine today is keeping the “care” in healthcare. One of the most frustrating aspects of practicing medicine for me had to do with how difficult it had become to incorporate caring into my practice. I am not necessarily talking about the kind of caring associated with having a long-term, close and mutually appreciated association with my patients: if that had motivated me, I would …
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Keep the care in the health care
In his recent TED talk, Atul Gawande harkens back to the central thesis of his recent book The Checklist Manifesto: How to Get Things Right
that medicine has become too complex for physicians to act as cowboys and instead should adopt the paradigm of a pit crew, utilizing teamwork and the humble checklist to solve problems and avert emergencies.
Is this really true though? Can “pit …
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Can pit crews really heal medicine?
The art of practicing medicine is in realizing that there is an overlap between normal variants and pathology. Being able to tell the difference can be difficult, but this where the art comes in. However, as physicians we must realize that sometimes this can not be differentiated. Radiology is no different. Many clinicians and non-health care professionals believe that radiology is cut and dry. There is no art in radiology …
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Help your radiologist out and provide as much history as you can
At no other time in my medical training was I as confident that, with hard work and dedication, I could master the field of internal medicine as when I was a newly minted third year medical student.
Fresh from having taken the USMLE step 1, I interpreted my ability to recite the mechanism of penicillin resistance or the role of histamine in the immune response, and describe in great detail the …
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Being a good doctor is no more an achievement than being a good Mom
I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday …
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What does a perfect pediatrics practice look like?
Recently I was asked, “How can I improve my Press Ganey scores?” Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals. Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS …
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Tips to improve your patient satisfaction scores
“You are too smart to do primary care.”
I have heard this far too many times, directed at me and at others seeking career advice. There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this. Smart, capable, successful trainees are discouraged from choosing primary care. It is perceived as a less prestigious pathway than specializing.
The knowledge base of primary …
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Primary care requires more than knowledge
On my way to the hospital last week, I heard a 26-year-old woman describe her experience of becoming deathly ill. When she first realized that the many bruises appearing spontaneously across her body were unusual, she was working as coffee shop to pay off school loans. With the urging of a friend, she went to see a physician. The diagnosis was acute leukemia.
Her job did not provide health insurance and …
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Am I going to die because I cannot afford the test?
Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated? Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.
Professor …
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Teams are key to solving the American health care crisis
