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.
No great artist ever sees things as they are. If he did, he would cease to be an artist.
-Oscar Wilde
The physical exam of the head and neck is both simple and challenging. Simple, in that even children are familiar with the shape of the face, the sheen of the eye, the curve of the ear, and the texture of the tongue. Challenging, because when complicated, interlacing structures malfunction, they send …
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The physical exam of the head and neck is both simple and challenging
My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films …
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Fewer physicians are taking call in rural emergency rooms
If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice.
I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights …
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Understand the medical economics of a primary care practice
“I have bipolar disorder. Can I be a doctor?”
It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …
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Can I be a doctor with bipolar disorder?
I recently finished my second month of internal medicine. I had a different attending physician for each month. It is interesting to see how two different attending physicians will approach similar conditions. There is a lot of flexibility in the standard of care. Neither of them is wrong by any stretch of the imagination. Just different.
It is also amazing how much of a difference a good, well informed resident can …
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How two different attending physicians approach similar conditions
Here’s a true story from the operating room:
Surgeon: Intern, what is the story behind this patient?
Resident Intern: Patient is a 51 year old female with breast lump on the left side, and 17 out of 20 lymph nodes positive for cancer.
Surgeon (speaking in a rather ‘as a matter of fact’ tone): Oh, she’s F_ _ _’d.
Resident Intern: shocked, frozen and unable to respond.
“How do some physicians become so stoic?” I …
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Physicians who are able to feel compassion
Revenue Cycle Management. What does it mean? In a nutshell, it means taking steps to assure that you get paid for what you do and that you get paid in a timely fashion.
The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient’s name, phone number, and maybe the name of their insurance company.
The cycle ends when the balance on their account …
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Revenue cycle management for your physician practice
Recently, I was reminded of the power of wellness. From the other side. And it came wrapped up in sound. Five words, to be precise.
I was instantly reminded how powerful a few words can be in the exam room.
We all want to feel wellness. The freeing kind, as in the way you feel when towered over by big objects. You know what I mean, the wide open wellness you feel …
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How powerful a few words can be in the exam room
It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.
That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …
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The biggest problem faced by pilots and obstetricians alike is nature
“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”
This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.
The community hospital has been keeping Stella Norris (not her real …
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The care was futile, and the patient’s wishes
Every illness is unique, and every person faces illness in his or her own way.
Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.
These individuals do …
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Let Me Down Easy and facing illness and death
As part of the routine scut of the overnight call team, I was sent up to the floor to preop an add-on for the next day’s OR schedule.
The Preoperative Anesthesia Assessment form has tidy little boxes for cardiac, pulmonary, renal, hematologic and an assortment of other complaints, and spaces for height, weight, allergies and personal or family history of untoward reactions to anesthesia. I put a single slash through the …
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Time with your patients in the hospital and time with your children
A reader recently asked, how does someone find a good psychiatrist?
Stated another way, the questions are:
- What qualities make a good, competent psychiatrist?
- How do I find a good, competent psychiatrist?
- How do I get my concerns heard about the direction of my treatment?
I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …
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What makes a good, competent psychiatrist?
by John LaBine
What are the root causes of communication inefficiencies in hospitals? Hovering around any given patient/case are many players, each with a huge variety of demands for his/her time, attention and presence. And they know there are costs of certain outcomes (medical errors, stress, wasted nurse/physician time, etc.). Each caregiver has his own long list of things to do, places to be, people …
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Hospitals need healthcare flight crews
Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.
What do I mean? Here are some examples from my field.
Treating …
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Difference between proactive and reactive medicine
One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes.
While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about Read more…
Teamwork helps doctors with patient safety
There are many reasons to sell your practice. Physicians attempt to sell their practices for various reasons. Some physicians are reaching the age of retirement, while others are looking to add a partner, who, in time will take over the practice as a whole. Whatever the reason, attempting to get a quality price for the practice can, at times, be a challenge in this current …
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Why physicians should sell their practice
Implantable defibrillators are truly life saving devices that have prevented sudden death in thousands of patients. No bigger than an iPod nano, the device can sense when the heart is beating irregularly and deliver an electrical jolt that kicks it back into proper rhythm. But like so many of medicine’s miracles, defibrillators are not always used on the right patients. According to a study published recently in the …
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Shared decision making to determine implantable defibrillator need
Very few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide. We are often left alone, with the painful questions,
“Why?”
“What could we have done differently?”
Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ideations in the …
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Your physician may be thinking about suicide
