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.
Unlike most other industries, safety in healthcare has a unique set of circumstances to overcome: 1) patients die from errors one-at-a-time, and 2) we rarely find out exactly why. The “sensationalism” from a front-page disaster is completely absent. And, due to a myriad of factors, the underlying hazards usually remain a secret.
As we ride the crest of a current wave of interest in “patient safety,” is the refreshing new focus blinding …
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The necessary steps healthcare must take for patient safety
When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).
The more I learn as a physician, the more I realize how little I know.
The …
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How technologists and insurers can help doctors
Marge was aging and gradually “falling apart”, as she would say. “First it was my back, then my knees, and now my heart is giving out”. She confronted her doctor with this in a frustrated manner, “I’m no good for anything anymore. I can’t really enjoy the things I used to. Most of my friends have died off, so maybe I’m next”.
The doctor in sizing up Marge’s advanced age and …
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A POLST form documents what patients value
Do you, or people you care about, have a chronic medical condition? There are all kinds of chronic diseases, but the ones that are most aggressively killing us—and the health care system—are heart disease, diabetes, and metabolic syndrome (a deadly combination of excess weight, high blood pressure, increased cholesterol and elevated blood sugar). These are all primarily lifestyle diseases and cancer should probably be on the list, too.
I felt sad …
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Don’t give up on your patients, some will absolutely amaze you
Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.
Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …
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Mexico needs more pediatricians
When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy. Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience. It is a process that requires effort and intention. Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response. Sympathy is important and is part …
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Empathy should be the basis of patient care
Primary care residency numbers didn’t change much this year. Depending upon your vantage point, that’s either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh …
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It’s time for a primary care workforce surge
Although my team, the New England Patriots lost Super Bowl XLVI to the New York Giants in one of the most exciting and tense games in recent memory, reviewing both the pre and post game coverage provided even more learning for doctors and healthcare than my prior post. One can demand excellence and still fall short. When one fails to achieve the intended goals, the learnings can be as …
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What health care can learn from a Super Bowl loss
It’s cool. So cool, that President Obama used one. So cool, it’s been on the cover of Newsweek. It’s been in multiple television commercials, radio advertisements, highway billboards, and was even coined one of the top 14 medical breakthroughs of 2011 by Boston Magazine, a city teeming with medical innovation. Yet surgeons and health economists are unable to explain the fascinating rise of robotic-assisted surgery.
Currently, a single company manufactures and …
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Why isn’t everyone excited about robotic assisted surgery?
I aspire to be Betty White when I grow up; she’s witty, funny, brilliant, and beautiful. I can’t wait to coo, “My eyes are up here,” to the hot guy who’s just busted down my door, when I’m 90 years old.
“What’s the secret to her vivaciousness?” I wonder. She is probably genetically gifted a la George Burns, but I bet she has done more to preserve her looks and her …
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How to be like Betty White when you get older
Every day physicians and other healthcare professionals are engaged in an invisible battle at work.
In one corner is our desire to help other people, make a difference and practice the skills we worked so hard to perfect.
In the opposite corner is burnout and it’s entire gang. Most of us don’t recognize burnout has a whole team on its side. We are outnumbered at least ten to one. I call this …
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Physician burnout: Why it’s not a fair fight
In advance of their annual User Conference, the social media team at athenahealth was able to talk about modern medicine with the event’s keynote speaker, Dr. Abraham Verghese. A physician and Stanford professor, Verghese has also authored several books, including the New York Times bestseller, “Cutting for Stone.” Here he talks about the importance of being present during the exam, in an era with so many distractions threatening to …
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Neglecting the patient in the era of health IT and EMR
A heretic essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student and resident and to pass any board certification exam in any specialty … in my humble opinion.
John Ioannidis became one of my personal heroes with the publication of his great paper in PLoS Medicine, “Why Most Published Research Findings Are False,” and its …
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Bias and error are rampant in medical literature
The manner in which a physician communicates information to a patient is as important as the information being communicated. Patients who understand their doctors are more likely to acknowledge health problems, understand their treatment options, modify their behavior accordingly, and follow their medication schedules. In fact, research has shown that effective patient-physician communication can improve a patient’s health as quantifiably as many drugs—perhaps providing a partial explanation for the powerful placebo …
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Essential patient communication tips for physicians
They say a good doctor needs to be able to stand in his patient’s shoes, but Stuart only had one; a size 12, left foot Nike Air Max. Back in May 1991, after his car ran off an Australian country road, wrapping itself around a gum tree, Stuart ended up losing a leg. In a photo taken at the scene of the accident the following day, you can see a …
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Empathy is an essential ingredient of the work of a doctor
It isn’t that it was a bad day, because it wasn’t really. There was too much work, yes, and I ended up staying late, but it was mostly made of good interactions and I felt generally competent. So, no, it wasn’t just a bad day. Still, this evening I feel like the best possible future would be one in which there was no technological medical care, where we just worked …
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Complex, painful and expensive medical procedures at the end of life
Parenthood. It has changed everything.
Snot on my sweater goes unnoticed. Hobbies gather dust in the closet. Kissing away the boo-boos and wiping away tears become daily ritual. Screams, laughter, tantrums, and toys crashing to the floor become the household white noise. All my Facebook status updates are about my kids.
Some people manage to continue their lives with style.
Me? I’m just tired. And I need a haircut. Smartypants would say I need a …
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A family bucket list is a reminder to have fun together
Last week was tough. I had to refer several patients to hospice, and a few more received bad news regarding their disease. This has always been the toughest part of my job, but it’s also the part patients need me to handle best. I have to remind myself that no matter how hard it is for me to give bad news, the patient and their families are the ones receiving …
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Doctors need to be better trained to deliver bad news
Dr. Lake used to be a businessman. His books were clean and orderly. His staff was efficient and kind. He steered his ship agilely through troubled waters and still managed to provide the highest quality care. His was not only physician but small business owner. He was proud.
As the political climate changed, Dr. Lake became more distressed concerning his situation. His overhead was increasing and the regulatory culture was expanding. …
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How primary care is sold down the river
If you live in southern California, you can’t miss the billboards advertising laparoscopic gastric banding at “1-800-GET-THIN” outpatient surgery centers. They feature happy people who’ve lost 100 pounds or more, and urge you to “let your new life begin” by having a “lap band” inserted. Fees at these centers are much lower than they are at university medical centers or other major hospitals.
Recently, however, those surgery centers and their owners …
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Why would anyone believe that cheap surgery is a good choice?
