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.
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.
The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …
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Quality indicators can harm the elderly
The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.
In Korean culture, questioning authority is unacceptable and led to …
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A culture of fear permeates the healthcare system
When it comes to doctor- nurse interactions, when is enough, enough?
Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to …
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Conflict between physician and nurse
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
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Advance planning should be a public health issue
I took a deep breath. I had to think carefully. It’s not that this was unexpected – Johns Hopkins has been anointed the country’s best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution.
One truth, however, cannot be denied: to call one hospital the best is not simple.
Let’s start with …
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Doctor, why is your hospital better than any other?
What causes a doctor to commit suicide?
A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in his …
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Did hospital politics lead to physician suicide?
It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch …
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The possibility of zebras in primary care
Almost four years ago now, I left my practice as an emergency medicine physician to enter the business world. However, the medical world isn’t easy to escape. I just couldn’t seem to forget some of the problems I used to face in the emergency department. So, when I had the chance to fix one of them, I took it.
The most intractable problem for me was fraud, especially as it related …
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Patient identity fraud in the emergency department
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …
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How political correctness interferes with healthcare
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman’s hair.
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia’s eyes opened and closed in an exaggerated blinking manner as she questioned me …
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Health quality requires looking at our caregivers
I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of everyone; …
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A doctor resolves to cut his heart attack risk
“I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest since you’ve been paid to do research on that medicine.”
“Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office.”
“It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the …
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Stop trivializing conflict of interest
The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight.
The …
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A good death is a right we must fight for
Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously …
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Saying no to your oncologist is sometimes the right thing to do
One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, …
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The erosion of psychiatric training has consequences
The instruments were indicating to the two co-pilots at the controls of the Airbus that they needed to pull back on the stick.
They held back on the stick for 54 seconds.
This is the position they were in when the Air France jet plunged into the cold water of the Atlantic killing everyone on board.
The fix?
Recognizing that a protocol or guideline might be giving them wrong instructions, seeing that there …
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They don’t make protocols for patients like me
How is a doctor allowed to mess around with body parts he doesn’t understand?
If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!
The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually …
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The myth of physician omniscience
Evidence-based medicine and health insurers generally focus on what’s medically necessary, not what’s epidemiologically relevant, not what soothes the mind of the bereaved or of the physician grieved and mystified by the loss of a patient.
Once, the autopsy was a venerated tool for medical advancement and humility. An invaluable means of learning one’s own limitations and the extraordinary diversity in nature and human physiology, it has now become an unreimbursed …
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A eulogy for the autopsy, and a call for its return
