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.
What exactly is the difference between a child psychologist and child psychiatrist? The two terms are frequently mistakenly interchanged, but the requirements for the two are considerably different.
To become a child psychologist, many programs require that you get an undergraduate degree in psychology, although some graduate programs will only require that you take the prerequisite sciences courses (biology, physical and social sciences, statistics, mathematics, etc.) before applying for the graduate …
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The difference between a child psychologist and child psychiatrist
“Superior doctors prevent the disease.
Mediocre doctors treat the disease before evident.
Inferior doctors treat the full-blown disease.”
-Huang Dee Nai-Chan 2600 BC; 1st Chinese Medical Text.
Not only does my work in integrative medicine have me on the front lines of big pharma-created “syndromes”, like chronic fatigue, fibromyalgia and irritable bowel (these are real for patients, but are not formal syndromes), but I get to see the worst of our sickcare system. I …
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Find a physician, not a general
In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.
At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.
For those that don’t choose a subspecialty, one choice remains: traditional …
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Young doctors don’t see value in primary care careers
Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently …
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Are doctors given more responsibility than they can handle?
When I first learned that the U.S. was going to develop a new specialty, the hospitalist, I was very pleased.
I had long believed from study and direct observation that some of the better healthcare systems in Europe were benefited in a major way by the general separation of office and hospital medical practices and practitioners.
In the U.S., historically most patients have been taken care of by physicians practicing medicine in …
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Is there truth to the unintended consequences of hospitalists?
“When is it time to break up with your doctor? It can be a tough decision to make. After all, if you don’t like your experience at a store, you shop somewhere else next time. If you go for a haircut and hate it, you find someone else.
With your doctor, it’s a bit different. This is someone who might know some of your deepest, darkest secrets. There is a history …
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When is it time to break up with your doctor?
Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes. So it is natural that patients have a hard time understanding it as well.
Therefore, I decided to summarize a conversation I had with a patient in an effort to help other patients understand, at the very least, a portion of how medical health …
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What patients need to know about coding
Sex sells. US Weekly and People fly off the shelves with the latest reality star drama. Unfortunately, the same does not apply to the diseases running rampant in today’s society. Is there an answer? I would like to say yes, but the ultimate answer remains to be seen. After my four years of undergraduate work and four more years of medical school, I am confident that there are a myriad …
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Why doctors need Hollywood
In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for “Big Barn”) still retained …
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The day our hospital lost its heart
Although as a medical student rheumatology was always associated with an air of mystery and complexity to me – factors which might have aroused a younger me had they been associated with a member of the opposite sex – the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980′s, rheumatology wouldn’t have got as far as a first …
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Why rheumatology is sexy
Historically, American physicians and surgeons were fiercely independent practitioners, who owned their own practices, worked long days and maybe longer nights, made a good income, but saw little of their families. They trained in a male-dominated world in “residency,” so named originally because their extended 120 hour/week work schedule demanded them living in dormitory type residence adjacent to the hospital.
They developed long-standing professional commitment to their patients that superseded time …
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Impersonal care from the new generation of physicians
In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors– a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting …
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Cancer rehab dramatically improves cancer care
Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.
Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with …
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The art of Alzheimer’s disease
My wife has two world-class oncologists who help her manage her stage 4 lung cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.
We all …
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The therapeutic value of touch in medicine
I am a third world doctor.
My patients have first world expectations.
Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.
In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn’t feel its own failure, …
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First world healthcare expectations in a third world country
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient’s room and give a shot of morphine. This …
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We are seeing more terminal patients being referred to hospice
Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.
My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …
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I will never be the physician that my father was
The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse.
No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or …
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Grief takes no holidays
I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive …
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The culture of medicine needs to change
I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.
On rounds, the attending of course …
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Useless thought experiments during medical school and residency
