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.
I am a physician who was diagnosed with throat cancer and underwent laryngectomy four years ago. Prior to being diagnosed and treated for cancer I did not welcome or encourage my patients’ participation in their own care. Admittedly, there were instances when such input was helpful, but more often I regarded patients with data based on information obtained from the Web as a challenge to my expertise and authority. I …
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I changed my perspective about patient participation in their care
“A 41 year-old woman with no documented medical history or family history of disease presents to you complaining of occasional chest pains on exertion. How many would order a stress test to rule-out cardiovascular disease?” asks Dr. Gary Bloch, to a captivated audience of resident physicians currently in training at an academic learning day – a few hands go up.
“Now how about if she were a smoker or had high …
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Why doctors should screen for poverty
By 2015, according to the American Association of Medical Colleges, the U.S. health care system will be short approximately 30,000 primary care doctors. Yet, everything we read says that primary care physicians are the linchpins of the new (really rediscovered) coordinated care models being talked about by health care policy cognoscenti. What gives?
Since the mid-1990s the number of medical students pursuing a career in primary care has been on a steady, sinking decline, …
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Skills primary care doctors of the future will need
The mother of the dead baby sat in her husband’s arms and simply asked “why?” over and over through the Vietnamese interpreter. I had no way to answer the question. I didn’t know why. There was nothing to point to. No defect in the child or mother or the actions taken in L&D.
All I could do was say “I am so sorry” … for your baby, for you … for …
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The double tragedy of medicine’s battlefield mentality
Emergency, as per the all-knowing Webster, is defined as an unforeseen combination of circumstances or the resulting state that calls for immediate action. Furthermore, an emergency is also defined as an urgent need for assistance or relief.
These definitions sound pretty spot-on, right? When thinking about emergency room settings, even, one can easily correlate the words of Webster to what one would …
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The obviousness of long waiting times in the emergency department
Using data from Medicare and private insurers, analysts at the RAND Corporation found that the rate of involvement of anesthesiologists for upper GI endoscopy and colonoscopy in low-risk patients had risen steadily over the last few years and is estimated to add $1.1 billion in what may be unnecessary health care costs. There was wide regional variation in the use of anesthesiologists which suggests that some or most of the …
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Why more colonoscopies need anesthesiologists
Slightly over a year ago, the Department of Justice (DOJ) launched an investigation of a large number of institutions regarding concerns that implantable cardiac defibrillator (ICD) procedures were performed for reasons outside of the criteria set forth in Medicare’s National Coverage Decision (NCD). This investigation occurred just after Al-Khatib and others published a report January 4, 2011 in JAMA that suggested as many as 22.5% of implantable defibrillators implanted …
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The problem of regulatory oversight and ICD implantation
Christopher Hitchens, noted author and philosopher, died December 15, 2011 leaving behind many essays, books, and other writings as well as contributing to several lectures, ethics/religion debates, and TV talk shows. His acerbic style often ruffled feathers as he attacked religious dogmatism.
As one of the most famous outspoken atheists of this era, his thoughts on being diagnosed with an incurable disease would be a powerful insight into how atheists might approach …
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Christopher Hitchens and the universal experience of dying
Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor visit.
The results of …
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How to discuss online health information with your physician
An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by a former chairperson of the much maligned Institute of Medicine, is that primary care doctors are over-using cancer screening tests because they do not understand the statistical ramifications and conclusions …
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Keep statistics simple for primary care doctors
One fine fall morning last year my wife turned to me and said: “I want a tummy tuck. There are no rules against you doing that for me are there?”
We had talked about tummy tuck surgery for her several times over the years. She had had a gastric bypass a decade before we had met and was a pretty good candidate. No cigarettes. Well she did have a few surgical …
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Doing the wife’s tummy tuck
Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.
Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …
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Why full code should not be the default status for patients
“It is getting worse everyday.” “Medicare fix at the last moment.” “Too much paperwork not enough time with patients.” “ACO’s and bundling.” The headlines scream at us everyday.
If we have one word that underlies the medical community it is fear.
The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching …
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Doctors need to find meaning in their work
Where is the physician outrage?
Right. Here.
I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.
I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.
I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape.” If I insert any …
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Physicians should rise up against mandated transvaginal ultrasounds
As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much.
Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, …
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The space between being a good doctor and a conscientious citizen
Recently there was a lovely story in the New York Times about a young couple struggling to navigate the complexities of a romantic relationship. Both in their early 20’s, dating is a relatively new experience for them. She likes physical affection; he prefers sitting alone on the couch. She wants a pet; he is allergic. They are learning to negotiate the small things while clinging to their common affection for …
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Sexuality in youth with special needs
I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced.
In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly …
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Honesty is the basis of communicating with patients
Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI … but not a single voice tells us how to do that.
Let me give you a three part structure you can use in your patient conversations in the future – and some exact words to try out. This structure is adapted from the Parenting literature, another role where boundaries and inappropriate …
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How to say no to inappropriate antibiotic requests
I cradled my son’s miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child.
At the time, it hadn’t sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing …
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A good thing we have mommy
