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.

An automated call center for your medical practice

Peter J. Polack, MD

Physician

January 3, 2011

Having an answering service is essential for the typical medical practice. But what about your regular call center? Do your front desk personnel answer the phone? Do you have a dedicated receptionist? Or a formal call center?

Outsourcing services seem to be on the rise and medical practices are beginning to realize some cost savings just like other businesses.

The trade-off of course can be the perception of less personalized service. Some …

Hospital meals make it difficult to control blood sugars

Roxanne B. Sukol, MD

Physician

December 30, 2010

My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …

Tips to find a good psychiatrist

Dinah Miller, MD

Physician

December 29, 2010

Seems like a simple enough question: How do you find a psychiatrist?

It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.

We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your …

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Tips to find a good psychiatrist

Reduce phone calls in your medical practice

Rosemarie Nelson

Physician

December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

Physicians need to take responsibility for their actions

Jeffrey Knuppel, MD

Physician

December 21, 2010

As the saying goes, when you’ve got a hammer, everything looks like a nail. Send a patient to a surgeon, and he very well might get surgery. Send a patient to a psychiatrist, and he very well may end up on psychotropic medication.

As physicians, we need to take responsibility for our own actions. We should not prescribe or perform procedures unnecessarily. However, even if we are responsible for our own …

The art of medicine and mastering relationships

Kevin

Physician

December 17, 2010

by Kelly, MD

There is a reason why people often say “the art of medicine.”

It’s not just the fact that so much of what we do is based on culture and habit rather than science, but also the fact that there is a lot of finesse when it comes to relationships as a doctor. Oh sure, we know all about patient-doctor relationships and its importance. There are …

The cost of keeping the terminally ill alive

Richard Meyer

Physician

December 16, 2010

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …

A physician story of addiction and recovery

Kevin

Physician

December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober. I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple. It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either. I know this …

A nurse and the system to deal with medical errors

Kevin

Physician

December 15, 2010

by Mary Lynn Summer

I am a nurse. Like most medical practitioners, I am afraid of malpractice attorneys and view them as a threat to my nursing license. Every hospital has a system in place to deal with medical errors and patient complaints. I used to think they worked, but now I don’t.

My mother, in her late 80s, recently broke her hip. She has dementia so is unable to appropriately express …

A poetry reading at Bellevue Hospital

Danielle Ofri, MD, PhD

Physician

December 14, 2010

The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn’t clear if the room could accommodate everyone.

This wasn’t the emergency room or the clinic waiting area, however. It was the scene of the Bellevue Literary Review poetry and prose reading. More than 100 people poured into Bellevue Hospital on a Sunday evening to …

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A poetry reading at Bellevue Hospital

Medical errors that involve handwritten prescriptions

Kevin

Physician

December 14, 2010

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more …

Physician time should be considered a resource

Kevin

Physician

December 13, 2010

Being a physician always has been a busy job.

This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and …

7 favorite ER superstitions

911Doc, MD

Physician

December 12, 2010

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Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.

1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …

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7 favorite ER superstitions

Good patient communication by managing expectations

Trisha Torrey

Physician

December 11, 2010

My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart! A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.

In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just …

The secret to better healthcare is the primary care physician’s brain

Richard Young, MD

Physician

December 10, 2010

When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism.

For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me “medical home” was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary …

Loss of an empathic connection between doctors and their patients

Richard Barager, MD

Physician

December 10, 2010

It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide.

An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients.

The author summarizes a …

Stercoral perforation as a deadly cause of colon rupture

Sid Schwab, MD

Physician

December 9, 2010

I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …

Intuitive and algorithmic decision making and The Simpsons

Tim Richardson, PT

Physician

December 9, 2010

One of the most popular Simpsons episodes ever – MoneyBART – succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy.

This struggle, catapulted to prominence in 2002 with the publication of Flynn’s manipulation rule, is not unique to physical therapists.

Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines.

Physical therapists share some commonalities with physicians in that we overestimate our …

Implementing site changes with Plan-Do-Check-Act

Donald Tex Bryant

Physician

December 8, 2010

Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients. Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill. They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes.

Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making …

William Osler’s humor, and finding fun in medicine

Dr. Chris Nickson

Physician

December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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William Osler’s humor, and finding fun in medicine

Physician

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