My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she …
The women behind ideological debates about abortion
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Many are unaware of the global anesthesia crisis in low-income countries around the world. Some countries have less than one physician per 10,000 people and even less than one anesthesiologist per 100,000 people. The ability to provide safe anesthesia for surgery, labor and delivery, and other procedures, …
ASA: The global anesthesia crisis in low-income countries
In these days of decreased reimbursement, increased workload, and non user-friendly EMRs, physician burnout rates can be quite high.
Stress, depression, and overwhelming fatigue associated with burn-out can interfere with our ability to care for our patients. If we, as providers, are not emotionally healthy, we are not able to provide the very best of ourselves to our patients. When we allow ourselves to become over extended and over committed without …
Strategies to prevent physician burnout
The problem with phone medicine is that you have to trust what you hear and act accordingly. Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses. Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone.
Patient’s mom: “My son is sick. He’s throwing up and has a …
The limits of telephone medicine
W. Edwards Deming is recognized as one of the driving forces that led the Japanese in the 1950’s to become a world-class manufacturing nation. The Japanese through the implementation of his principals became leaders in the manufacture of automobiles and electronics. One of his cardinal principles was that a company must delight its customers. It is not enough for a company that wishes to excel to meet the needs and …
Engaging employees to improve patient satisfaction
(All names and identifying features of characters in this story have been changed.)
Nora, a third year medical student, came to me in moral distress.
Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.
The first year doctor with whom Nora was paired, Dr. White, vented to her:
“These patients come to us seeking our help and then refuse …
Does leaving against medical advice stick patients with a bill?
Since the America Society of Plastic Surgeons (ASPS) released their 2011 plastic surgery statistics, I’ve seen a lot of talk online about how, “despite the economy,” plastic surgery numbers are rebounding from the lows they hit in 2007 and 2008. People say this as if plastic surgery is—against all odds—somehow rising above the general trends and setting unprecedented records.
I can see why it’s tempting to frame it that way—while the …
Plastic surgery as an economic indicator
In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn’t relax, and I was always irritated. Even a few days off didn’t help because of the mountain of phone calls and paperwork waiting for me upon return to work. I asked myself, is this burnout?
Coincidentally, I happened …
How locum tenens can solve physician burnout
Want more evidence about how many people expect perfect outcomes in medical practice?
Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro.
As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and …
How many people expect perfect outcomes in medical practice?
One of the curses of kalafong (hell) was that there was no neurosurgical service. This meant us mere general surgeons had to handle the many head injuries that came in.
So, for example, when some guy decided to cave in the head of his so-called best friend with a five iron on the golf course because they had started with the nineteenth hole instead of the first, we ended up either …
Extubating the overzealously intubated patient
After my recent blog posts, I was inundated with questions regarding how I would change the way I interact with my cancer patients if I return to work. I’ve tried to chronicle my experiences – from diagnosis to death – in hopes that you will learn how you can interact with your patients more effectively.
Diagnosis
There was an undeniable shock that disrupted all of the carefully-constructed systems and routines with …
When it comes to cancer, do not just focus on survival
A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.
Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.
Many pundits have weighed in on whether …
Is it necessary for a doctor to examine you on each visit?
We specialists in infectious diseases love case conferences — especially those where the case is presented as an “unknown,” and we try to figure out the diagnosis from the history.
I suppose this isn’t very surprising, since ID cases in general are already among the most interesting in all of medicine. Those that are case-conference-worthy are particularly prime.
“Funny bug in a funny place,” was how one of my colleagues characterized these …
What is your case conference personality?
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Autopsies establish truth, detect change, provide hard data, instruct learners, and promote justice. Yet, they seem poorly valued in modern America except in many TV crime shows like “CSI.”
Dr. Donna Hoyert of the CDC, in August 2011, profiled the dramatic changes in American autopsy rates, noting that while forensic autopsies remain common, hospital autopsies for patients with diseases, especially in the elderly, have almost disappeared.
In evaluating …
Who does not like autopsies and why?
There’s been a great divide between the medical and surgical specialties ever since I can remember. Surgeons believe internists perseverate too much when decisions need to be made. Internists consider themselves the true intellectuals of medicine. I suppose anesthesiologists like me fall somewhere in the middle–we work in surgery, but have to take care of all the medical problems the patient brings to the OR table. Does that make us …
Are anesthesiologists the last true generalists?
There was an exceptionally well-written piece published in the Washington Post recently. I presume a hospitalist wrote it, which magnifies its significance. In it, he describes the difficulties in caring for terminally ill patients.
As I read it, it reminded me of a story my dad told me several years ago. His friend, I will call him Steve, was experiencing a great deal of stress because of his dad’s ailing …
Overtreatment and the ethics of end of life care
A couple of weeks ago, the New York Times published a story entitled I Disclose … Nothing by Elisabeth Rosenthal. The premise of the article dealt with conflicts of interests in several professions, including those in medicine. It got me thinking about whether or not the concept of disclosure can successfully manage conflicts of interest in medicine as much as people expect it to.
The conclusion I …
Why medicine will still be plagued by conflicts of interest
Numerous studies have shown that an average of 1 in 3 practicing physicians are suffering from symptomatic burnout on any given office day worldwide, regardless of specialty.
The three classic signs and symptoms of burnout are measured by a standardized evaluation: the Maslach Burnout Inventory (MBI).
They are:
1. Emotional exhaustion
The doctor is tapped out after the office day, hospital rounds or being on call and is unable to recover with time off. …
Physician burnout presents differently in male and female doctors
As my husband and I try and make a long term financial plan for paying off my almost $200,000 in loans from medical school, I sit here wondering, why did I pay 200 grand so that I can get peed on, pooped on, bled on, screamed at and sworn at? I’ve delivered a baby without gloves on (it was an emergency). I’ve been kicked so hard I almost fell off …
Taking care of patients is a great honor
Four brutally honest declarations:
1. I can perfectly decide what is best for myself, my family, my patients, and my practice. I don’t need outside guidance telling me how to lead.
2. I decide what works best on my terms to practice the best medicine.
3. I will succeed and lead because I am focused on my goals just as much (if not more) than my patient’s goals.
4. My goal is to make …
Doctors need to stop being so complacent
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