Physician

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.

Hospice professionals have the heart of an amateur

Andy Milligan, RN

Physician

February 5, 2012

Most of us who work in medicine refer to ourselves as professionals and for good reason. Years of education, training, and experience make you the clinician you are. Hospice professionals in particular require a very special set of skills to care for patients and families. You are truly professional in caring for the whole person.

When it comes to sports there is a clear line of distinction between professionals and everyone …

ACP: Medical ethics should be a daily aspect of care

Fred Ralston Jr., MD and Lois Snyder, JD

Physician

February 5, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms?

For the patient and for the physician in practice, medical ethics is — or should be — a daily aspect of care. …

Susan G. Komen and the politics of women’s health care

Dominic A. Carone, PhD

Physician

February 4, 2012

Despite the adversarial political climate that divides so many Americans, there are some topics that most people can agree on regardless of politics. One of those is that early detection and screening for cervical cancer and breast cancer are important initiatives that should be supported because early detection leads to earlier treatment which, in turn, saves lives. While many women have such exams paid for by their health care insurance, …

Experiencing an uninvited gift

Carlene Oleksyn

Physician

February 3, 2012

It’s been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.

My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.

That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I …

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Experiencing an uninvited gift

Are physicians addressing the root causes of health problems?

Ricky Choi, MD

Physician

January 31, 2012

While in residency, I took care of a toddler who was hospitalized following an anaphylactic reaction. During a diaper change at home the child suddenly developed lip swelling and severe difficulty breathing for no apparent reason. The child was urgently brought to the hospital by ambulance and initially treated in the emergency room. By the time I met her on the inpatient floor her breathing and swelling had significantly improved. …

Be aware of your food choices, especially when pregnant

Eric Marcotte, MD

Physician

January 31, 2012

I come back into the exam room, keeping my best poker face, sit down and turn to face her. She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.

“Congratulations,” I say. She lets out her breath and smiles, huge.

“Thanks!”

Once the adrenaline settles down and she can hear me again, …

How algorithm driven medicine can affect patient care

Jeffrey Parks, MD

Physician

January 30, 2012

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of …

The sense of loss extends beyond the death of a patient

Don S. Dizon, MD

Physician

January 29, 2012

At the end of the year, I find myself thinking about patients usually—and especially those that have passed away. I wonder how their families are coping, how their children are, and whether each day has gotten easier. I think about how my patients died—and whether or not I did enough to ensure that they did not suffer.

It’s an odd thing …

Patients will understand an honest mistake if the doctor tells the truth

Neil Baum, MD

Physician

January 28, 2012

It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x …

Diagnosing an illness is an art

Stewart Segal, MD

Physician

January 27, 2012

Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …

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Diagnosing an illness is an art

Physicians have a natural role as advocates

Danielle Rosenman, MD

Physician

January 27, 2012

As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, …

Our society expends huge sums on futile care

Jim deMaine, MD

Physician

January 26, 2012

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …

I learned the value of listening to the patient

Peter Elias, MD

Physician

January 25, 2012

William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”

I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery …

Repeated experiences of shaming are not good for a young child

Claudia M. Gold, MD

Physician

January 24, 2012

The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly worn out and exasperated, ran after him, grabbed him by the arm and said in a harsh whisper, “You must stand here!”

We were on line waiting to board a Southwest Airlines flight. For those of you not familiar with the Southwest system, there are no assigned seats. Rather, …

Insider tips to surviving your hospital stay

Happy Hospitalist, MD

Physician

January 24, 2012

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.

10. Bring your own pillow. Trust me.

9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.

8. Bring an accurate and updated medication list …

Being treated like a celebrity when giving birth

Linda Burke, MD

Physician

January 24, 2012

Celebrity is an interesting phenomenon.

On a hot summer night in 1990, my chief resident and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, Mo’ Better Blues. …

Why the family meeting is important

Jeffrey Alderman, MD

Physician

January 24, 2012

“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.

“I’m afraid so.” I replied.

“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.

We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown …

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Why the family meeting is important

There is scope for harm when ordering tests

Dr. Joe Kosterich

Physician

January 22, 2012

As the world speeds up we tend to assume that newer must be better. In some instances it is but when it comes to health, less so than one might expect. The other tendency is to overlook simple solutions and go to complicated, and often expensive ones.

In medical practice there is one step even before considering what to do with a given problem and that is whether there is a …

Paperwork causes unintended distractions for physicians and nurses

Christopher Chang, MD

Physician

January 21, 2012

I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.

There is no question that electronic devices distract physicians as the article pointed out. But that’s like complaining about a leaky faucet when there’s a flooded basement …

Stories help the public make sense of evidence

Kenneth Lin, MD

Physician

January 20, 2012

Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of “saved lives.”

I answered that evidence-based medicine’s supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a …

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