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.

Expanding hepatitis B vaccine recommendations for adults

Physician
November 7, 2010

My colleagues at the Advisory Committee on Immunization Practices (ACIP) are examining a proposed policy for hepatitis B vaccination for diabetic patients. If accepted, this would be the next in a series of baby steps expanding hepatitis B vaccine recommendations for adults. While we are taking these baby steps, HBV incidence rates among U.S. adults remain pretty flat, and they haven’t changed much since 2006.

We know the vaccine works. We …

Read more…

Expanding hepatitis B vaccine recommendations for adults

How fear may lead to infidelity

Physician
November 6, 2010

When we think of infidelity as “mere cheating” we are often overlooking the many fears that go along with this. Infidelity may be due to fears and fears themselves may lead to infidelity. Why is this, and what can you do about this?

1. Fear of being trapped. One of the greatest fears of commitment is the fear of being trapped. When people feel trapped, their primitive brains start to rebel. …

Read more…

How fear may lead to infidelity

Grateful for a medicine career in public health

Physician
November 5, 2010

I have made a big life-changing, evolutionary decision: I am leaving my job with public health. It was not an easy one. It isn’t because I don’t love my job greatly; because I do. In fact, I feel like the queen of the jungle, leaving her subjects. It’s not easy to let go.

My reasons for leaving have nothing to do with the job itself, but have everything to do with …

Read more…

Grateful for a medicine career in public health

Conflicting stories on alcohol and heart disease

Physician
November 4, 2010

Have you ever had a cold beer after a mountain bike ride?

Oh my!

But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable?

These are questions I am asked frequently.  And for those asking, they are very important questions.

I wish the answer was straightforward.  But it is not.

Undoubtedly, excessive alcohol can precipitate an abnormal rhythm.  Look no farther …

Read more…

Conflicting stories on alcohol and heart disease

Involving a psychiatrist in a patient’s care for the first time

Physician
November 4, 2010

The psychiatrist knocks on the door of the patient’s hospital room.

Patient: “Come in.”

Psychiatrist: “Good afternoon, Mrs. Jones. I’m Dr. Moodbetter, one of the psychiatrists here. Your doctor asked me to see you. Did he say anything about this?”

Patient: “No, he didn’t! You know, I’m not nuts. I didn’t think he believed me. Great. Now he just thinks it’s all in my head.”

Psychiatrist: “Well, I don’t think he meant to imply …

Read more…

Involving a psychiatrist in a patient’s care for the first time

Use technology and outsourced services to improve practice efficiency

Physician
November 3, 2010

What does it cost to improve operational efficiency using technologies and outsourced services?

For some physicians, the first reaction to every new service or technology is that it’s going to “cost too much.”

And you get pitches for plenty of new services:

* Your clearinghouse vendor or your billing manager wants you to push all your claims, even the claims you can file directly at no cost, through the clearinghouse for efficiencies.
* Your …

Read more…

Use technology and outsourced services to improve practice efficiency

Doctors are quietly opting out of medicine

Physician
November 3, 2010

shutterstock_162044975

Dr. Ryan Flesher was working his usual shift in the emergency department that night in July of 2006.  The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors.  Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.

The following is a true story that occurred well before healthcare …

Read more…

Doctors are quietly opting out of medicine

Spanking your kids and corporal punishment

Physician
November 1, 2010

Something recently stopped me in my tracks.

A study published in Pediatrics recently found that 65% of parents to 3 year-olds said they had spanked their child within the last month. Sixty five percent? The number surprised me. If you’d asked me to guess, I would have said 20-25%. Talk about way off. Another reminder of how much I have to learn.

The study evaluated risk factors, including domestic violence and intimate …

Read more…

Spanking your kids and corporal punishment

Doctors should embrace feedback and learn from it

Physician
October 31, 2010

In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.”

It would be better for Dr. Ofri’s patients if …

Read more…

Doctors should embrace feedback and learn from it

10 things you need to know before surgery and during the hospital stay

Physician
October 29, 2010

by Winston F. Mitchell

I’m a 53 year-old male with no history of hypertension, no cholesterol problems and glucose count normal.

I was overweight but still in great physical shape. But over a period of weeks, walking to work, I started experiencing a shortness of breath.  Finally I went to my doctor, he informed me he was going to admit me to the hospital immediately because a …

Read more…

10 things you need to know before surgery and during the hospital stay

Physician email implementation inertia

Physician
October 29, 2010

by Jon Meyer

Looking at the industry response to the recent study released by the Center for Studying Health System Change, Physicians Slow to E-mail Routinely with Patients – Issue Brief No. 134, it appears that a piece of the puzzle is missing. Both the study, and the analysis, put the physician at the center of the email debate. In reality, about 30% of a medical practice’s communication is from the …

Read more…

Physician email implementation inertia

US News hospital rankings too subjective and encourage self-promotion

Physician
October 28, 2010

Every year US News & World Report publishes its rankings of the nation’s top 50 hospitals. Hospital administrators await this top 50 report with a tension and fervor that rivals the NFL first-draft pick.

As soon as the report is released, snippets rocket their way into donor appeals, local hospital signage, and highway billboards. “Ranked X by US News & World Report” becomes a descriptor that is supposed to …

Read more…

US News hospital rankings too subjective and encourage self-promotion

Comparative effectiveness research needs to be taught to doctors and patients

Physician
October 28, 2010

Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.

An interesting article in the Journal of Clinical Oncology …

Read more…

Comparative effectiveness research needs to be taught to doctors and patients

ADVERTISEMENT

A physician seeing the husband and wife together

Physician
October 27, 2010

As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that  may be considered difficult to handle and that require a good deal of tact and confidentiality.

This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …

Read more…

A physician seeing the husband and wife together

EMTALA and why this emergency physician is against it

Physician
October 26, 2010

by 911Doc, MD

American medicine will die or be reborn in the next ten years. Correction, it will either continue an accelerated slide into banal mediocrity, or be reborn. The battle is finally joined, and it has been joined by the specialists. Thank you, doctors, for drawing the line in the sand. I hope you win. Honest.

I am cheering against my own college here because they have …

Read more…

EMTALA and why this emergency physician is against it

Technology empowered direct pay primary care

Physician
October 26, 2010

by Anar Mikailov

By now it is common knowledge that primary care is an undesirable field for newly graduating medical students.

Additionally, many current primary care physicians are closing shop and either enter early retirement or seek non-clinical professions. According to the American Academy of Family Physicians, the 2010 Residency Match showed that 1,184 U.S. medical grads chose Family Medicine, less than half of the available positions …

Read more…

Technology empowered direct pay primary care

Senior leaders need to periodically reflect on their role

Physician
October 25, 2010

Leaders often think about succession plans for their direct reports, but what about themselves?

What if I had a serious health problem or accident that impaired my ability to lead my IT organizations? Here’s my brief analysis.

Beth Israel-Deaconess Medical Center

My role at BIDMC is to document the strategies prioritized by our governance groups, ensure our organizational chart structure is optimized for executing the strategies, …

Read more…

Senior leaders need to periodically reflect on their role

Physicians need to consider a digital resume

Physician
October 24, 2010

As a physician coach to doctor clients making the transition from clinical practice and seeking out new careers, I latched onto a recent article in the Los Angeles Times business section.

Titled “Revive your Resume” by Emily Hughey Quinn, it hints at the death of the traditional paper resume. In its place is the digital resume you create on sites such as LinkedIn and VisualCV.

Take special note – if you’re a …

Read more…

Physicians need to consider a digital resume

Will a higher demand for generalist doctors save primary care?

Physician
October 24, 2010

by Ali Khan, MD

“So, why didn’t I take the ROAD again?”

It’s a question that I regularly hear from many of my co-residents in internal medicine – and no, we’re not questioning our travel routes to the hospital.

We all know why we chose internal medicine: the intellectual challenges inherent in treating across organ systems, the excitement of primary scientific investigation and diagnosis and the like. As we …

Read more…

Will a higher demand for generalist doctors save primary care?

603
pages