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.

When to use a new technology and when to die with dignity

Stephen C. Schimpff, MD

Physician

July 29, 2011

American medicine overuses its technologies and innovation triumphs and way underutilizes old fashioned compassion, discussion and good common sense.

Over the past twelve weeks I have given weekly updates of medical megatrends in the fields of genomics, stem cells, transplantation and vaccines. These advances are the representation of innovations and entrepreneurship in biological, computer and engineering science. They are exciting advances and offer promise of hope …

People accuse doctors of not doing enough, or doing too much

Doctor Grumpy, MD

Physician

July 28, 2011

Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We’re caught between doing what’s best, without putting the patient through too much, and doing what’s needed to protect ourselves from legal action.

Let’s take Mrs. Summer. She’s a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw …

Why primary care is due for a renaissance

Dave Chase

Physician

July 28, 2011

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to …

How a doctor learned how to suture

Fizzy, MD

Physician

July 27, 2011

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …

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How a doctor learned how to suture

What is defensive medicine in obstetrics?

Amy Tuteur, MD

Physician

July 26, 2011

Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.

Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.

Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.

There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven …

Perfect is the enemy of good when it comes to work-life balance

gcs15, MD

Physician

July 26, 2011

Over the years, I have come to the painful realization that I am not perfect.

Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don’t read this, patients, because you wish even more than I do that I were perfect (especially when I’m operating on you). But it’s true.

Long ago, I remember feeling …

How to be a star intern, from a former nurse

Albinoblackbear

Physician

July 26, 2011

This is another installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you’ll be received. I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.

Introduce yourself. There is …

If I could pick patients, they would be Native American Guatemalans

Chris Porter, MD

Physician

July 25, 2011

Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.

A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also …

Are psychiatrists rushed, uncaring, and in it only for the money?

Dinah Miller, MD

Physician

July 25, 2011

Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …

Being a primary care doctor is an utter privilege

Wendy Sue Swanson, MD

Physician

July 25, 2011

Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.

Yesterday afternoon I sent out this tweet:

It was a spontaneous tweet in the middle of my 15 minute “lunch break” when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a …

The secret in caring for the patient is to care for the patient

Jim deMaine, MD

Physician

July 24, 2011

Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik …

A Physician Family Office for high net worth families

Arnold C. Friedman, MD

Physician

July 24, 2011

As a middle-aged physician all too aware of the fact that we are all merely “passing through” life on our way to somewhere else, I am increasingly concerned with having a good work-life balance. Gone are the days of my residency when I was only able to catch a couple of hours of sleep here and there and be lucky to have the time to eat a fast food …

Poor, illegible entries in medical notes can cost lives

Norman Briffa, MD

Physician

July 22, 2011

I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in …

The role of non-physician clinicians in primary care

Cedric Dark, MD, MPH

Physician

July 22, 2011

With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.

The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …

How an allergy specialist reaches out to PCPs

Paul M. Ehrlich, MD

Physician

July 22, 2011

Every chance I get, I do a grand rounds with pediatricians and other PCPs to promote what you might call Allergy & Asthma 201, and also welcome as many residents as is practical for rotations in my office. The reason is straightforward—I have plenty of new patients who need the specialty care that an allergist can provide — both my accountant and I are happy to have them — but …

How much medical care are doctors obliged to provide?

James Logan, MD

Physician

July 22, 2011

I couldn’t pass up the opportunity to comment on Dr. Karen Sibert’s recent op-ed piece in the New York Times. She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting interests, such as raising a family, should take lower priority. I worked …

The benefits of successful patient self-management programs

Mark Novotny, MD

Physician

July 22, 2011

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can …

Hidden meanings behind the chief complaint

Emily Gibson, MD

Physician

July 21, 2011

Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots. There is a column for the name of the patient, the patient’s age, and always there is a place for the reason for the visit–the “chief complaint” according to medical parlance.

A quick review of the “chief complaints” for the day gives the physician a sense of how clinic will flow. There are the seemingly “quick” concerns, …

How the landscape of physician hiring is changing

Jocelyn Clarke

Physician

July 21, 2011

The majority of new job openings for physicians are now as hospital employees, not in private practice.

This is the new reality for both residents facing the employment landscape and seasoned physicians looking for better opportunities. In their 2011 Review of Physician Recruiting Incentives, Texas-based national physician search firm Merritt Hawkins confirmed that private practice scenarios are giving way to doctors being directly employed by hospitals, large health systems, and medical groups.

As …

Clinical competence, and whether a doctor is good, or not

Richard A. Foullon, MD

Physician

July 20, 2011

Is Dr. X a good doctor?

Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …

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