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.

Not engaging in end of life discussions is grounds for malpractice

Kevin

Physician

July 4, 2011

by Barry Massie, MD

It’s not that I am fixated on death, but recently, the CMS (Medicare) has decided not to pay for discussions with patients about prognosis and planning end of life care.

Reimbursement for such discussions was a key aspect of the health care reform legislation passed this year, and was widely mischaracterized as establishing “death panels.” I cannot imagine a legitimate justification …

How direct primary care reduces primary care costs

Dave Chase

Physician

July 1, 2011

In an age of family physicians literally not being able to give away their practices, Brian Forrest has built a successful model that is similar to the age of Marcus Welby where there was a direct relationship between a patient and their doctor. Practices such as Forrest’s Access Healthcare in North Carolina run unencumbered by insurance hassles.

As word of Dr. Forrest’s Read more…

How direct primary care reduces primary care costs

When you close an abdomen after a failed rescue, the OR is silent

Sid Schwab, MD

Physician

June 30, 2011

I didn’t know her name until it was over, much too late.

What I knew was she was thirteen and that on this winter day someone in her family had been pulling her behind their car, on a sled. No doubt laughing and looking in the rear-view mirror, the person driving had whipsawed around a corner, and the young girl — probably screaming (fear? delight?) — held onto the sled as …

The decision point psychiatrists faced with psychotherapy

Daniel J. Carlat, MD

Physician

June 29, 2011

There’s been plenty of buzz about a recent New York Times story, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” by Gardiner Harris. The story is essentially a profile of Dr. Donald Levin, a 68 year old psychiatrist who has a private practice in Doylestown, Pa.

It is a poignant example of a common situation in psychiatry. Older psychiatrists were trained during a time when there …

How ordering tests sometimes have consequences for patients

Stewart Segal, MD

Physician

June 28, 2011

Sometimes, you just can’t win! In medicine, sometimes is way too often. “Doc, do I need that test?” reviewed the issues surrounding screening colonoscopy exams. The dilemma is always the same. Do I order a test or don’t I?

If I order a test, there are consequences. Some are obvious; some are not. Tests cost money and money is in short supply. One consequence of ordering a test …

Why doctors shouldn’t leave their emotions behind

Michael A. Zadeh, MD

Physician

June 28, 2011

Part of the reason I became a physician was because I got tired of watching those close to me as they suffered through illness and eventually died, while I stood helplessly by, unable to do a thing.

Throughout my training I watched as my mentors interacted with their patients, displaying a political correctness matched with just enough outward emotion so that there was no telling the difference between the good news and the bad.

“Don’t …

How to review the performance of your office staff

Rosemarie Nelson

Physician

June 28, 2011

Your staff members are your most important (and costliest) resource. Have you invested in them? Do they know what is expected of them? Have you asked them if they have what they need to do their jobs?

Optimizing staff performance is a process. It starts with a plan, not the formal performance review.

You can’t do a successful performance evaluation without establishing accurate standards against which the employee’s performance can be …

Surgeons with depression and suicidal thoughts don’t get the care they need

Brian Goldman, MD

Physician

June 28, 2011

When you think of surgeons, you likely picture heroes deftly using scalpels to pull patients back from the brink. But sometimes, as much as surgeons want to save someone, they simply can’t. A new survey finds that some of the men and women doing amazing feats of medicine in the OR don’t think quite so highly of themselves.

Suicidal thoughts could be the result of depression and job burnout. …

How a day in the emergency department is a microcosm of real life

StorytellERdoc, MD

Physician

June 25, 2011

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies–hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that …

Frustration when a government does not provide the necessary health care

Yann Meunier, MD

Physician

June 25, 2011

Year: 1988

Setting: Electricite de France clinic at Daya Bay, China
Position: Resident physician

A Japanese encephalitis epidemic has struck southern China and I am in its midst at Daya Bay where Electricite de France is building a nuclear plant for the Chinese government. As the resident physician for the company, I see the local employees and their families. They all get immunized against the disease with the inactivated virus Biken vaccine, …

New fields in general surgery and the rise of the surgical hospitalist

Skeptical Scalpel, MD

Physician

June 24, 2011

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

Doctors are asking whether the physical exam is becoming a lost art

Jan Henderson, PhD

Physician

June 24, 2011

The physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It’s one way a physician attempts to determine the cause of a patient’s complaint.

In recent times, doctors have asked themselves whether the physical exam is becoming a lost art. It’s been replaced by an array of laboratory tests and high tech machines that …

Reasons why your doctor is running late

Emily Gibson, MD

Physician

June 24, 2011

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. …

Read more…

Reasons why your doctor is running late

Tips to make the most out of your national medical meeting

Christian Sinclair, MD

Physician

June 24, 2011

Here is the latest edition of Handy Hints for a National Meeting. The original version was written in 2005 (editions have been more often than yearly).

My first national medical conference was a whirlwind of new ideas and experiences some of which I was not necessarily prepared for.

General

If you are bringing family or a significant other, spend some time with them.
If you don’t bring family or a significant other, leave something nice for …
Read more…

Tips to make the most out of your national medical meeting

Why the annual physical exam is essential to both doctors and patients

Steven Reznick, MD

Physician

June 22, 2011

I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn’t matter. It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history …

Difficult testing decisions for parents with premature babies

Jennifer Gunter, MD

Physician

June 22, 2011

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.

When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …

Why physicians are not wealthy

Michael Zhuang

Physician

June 21, 2011

“Money talks. Mine just says goodbye.” A physician client of mine once grumbled to me. He is in good company.

Physicians by and large, are horrible wealth accumulators. Thomas Stanley, author of The Millionaire Next Door, found that among all high income groups, physicians have the lowest tendency to accumulate substantial wealth.

This finding is not at all surprising to me. My wealth management practice focuses on physicians, so I’ve seen …

Read more…

Why physicians are not wealthy

Hospitalists should limit the number of patients they see

S. Irfan Ali, MD

Physician

June 21, 2011

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

Medical practice career choices commonly become medical business failures

Kevin

Physician

June 21, 2011

by Curt Graham, MD

Never in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today. These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.

They’re not retiring. They’re adapting. Extended …

How physicians should deal with angry patients

Steve Wilkins, MPH

Physician

June 21, 2011

I highly recommend you take a look at “10 Dumb things you do at the doc’s office.” Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.

While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments. A lot of people feel disrespected by their doctors, …

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