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.

Every patient deserves a death with dignity and without pain

George Lundberg, MD

Physician

August 3, 2010

Death is not the enemy. We all die.

The enemies of patients and physicians are premature death, disease, disability, pain, human suffering.

I believe that all people deserve a death with dignity and without pain. Palliative care is the right mode for as many as 80% of all Americans who will die of chronic progressive incurable diseases. Eighty percent of those state that they do not want to die in a hospital …

Non-clinical physician job starting salaries

Joseph Kim, MD, MPH

Physician

July 30, 2010

What are entry-level non-clinical physician job salaries?

Let me clarify what I mean by “entry-level” here: I’m referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a consulting company).

So, let’s look at several examples:

* A primary care physician who’s making $120k/year leaves clinical medicine and begins …

How industry money continues to influence orthopedics

Ford Vox, MD

Physician

July 30, 2010

Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.

The …

Why patients are wary of the primary care medical home

Kevin Pho, MD

Physician

July 29, 2010

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.

And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the …

How the Massachusetts gift ban hurts primary care doctors

Kevin

Physician

July 29, 2010

by Kate Atkinson, MD

Six years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged insights while challenging each other on how best to manage our challenging patients.

Our group grew …

The way we practice primary care doesn’t make sense

Kenneth Lin, MD

Physician

July 27, 2010

You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.

Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …

Preventing postop infections need to be implemented as a package

Kristina Fiore

Physician

July 27, 2010

by Kristina Fiore

Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.

When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.

But the three core infection prevention measures taken …

Best Doc in a magazine, the inside story

Doctor Grumpy, MD

Physician

July 25, 2010

You’ve seen it, somewhere.

Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.

Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.

And I know most of the other neurologists on the …

Paying cash to doctors affects the treatment plan

Jay Parkinson, MD

Physician

July 24, 2010

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

Read part one here.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always …

Good medicine sometimes makes patients unhappy

Ralph Gordon, MD

Physician

July 24, 2010

As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?

In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

Read more…

How can doctors minimize unnecessary testing?

Data and transparency is needed to reduce medical mistakes

Kevin

Physician

July 21, 2010

An excerpt from On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry.

by John Toussaint, MD, and Roger Gerard, PhD

Admitting Error

In a lean environment, doctors and nurses must allow mistakes to be visible in order to perform root-cause analysis and fix the process. But showing mistakes hits most medical providers in a vulnerable place—right in the collective fear of lawsuits and a highly conditioned need to be …

5 principles of self-care for health professionals

Lisa Chu, MD

Physician

July 20, 2010

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.

Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your …

Prior authorization required by health insurers impedes primary care

Kevin

Physician

July 19, 2010

by Charles R. D’Agostino, MD

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly …

Why doctors run late and how patients can help

Jill of All Trades, MD

Physician

July 15, 2010

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of …

Why having a primary care physician is important

Kevin

Physician

July 15, 2010

by Chrysalis

I read a post that disturbed me the other day. It was discussing the value of primary care physicians (PCPs). I was stunned by some of the comments. Surprised that people’s perceptions of what a PCP does would be viewed in such a poor light.

Well, I do value the primary care physician and I’ll tell you why. I am just simply going to state some of …

Why this doctor felt compelled to go to Haiti

Kevin

Physician

July 15, 2010

by David Chong, MD

As the world watched the greatest athletes gather to compete in Vancouver, I was on a plane to Haiti. Just getting on the plane was quite a feat.

After I received an urgent e-mail for volunteer doctors from the University of Miami’s Project Medishare field hospital in Port-au-Prince, Haiti during an overnight shift at New York’s Presbyterian hospital, I began to send frantic requests for coverage for …

Fire in the OR and how hospitals should report medical mistakes

Maggie Mahar

Physician

July 14, 2010

Did you know that if there is a fire in the OR during surgery hospitals in some states don’t have to report the event to anyone?

When I read a recent story in the Cleveland Plain Dealer headlined, “Reporting Surgical Fires Could Improve Patient Safety in Ohio, Experts Say,” I was stunned.

The piece begins:

When fire breaks out and burns a patient during surgery in Pennsylvania, the hospital is required by law …

Read more…

Fire in the OR and how hospitals should report medical mistakes

Cancer in a transplant kidney, is it the doctor’s fault?

Amy Tuteur, MD

Physician

July 13, 2010

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting …

How this OB/GYN handled her unexpected maternity leave

Kevin

Physician

July 12, 2010

by RH+, MD

About 3 weeks after my son was born I read this post and I was extremely jealous as I read about the author’s extended leave. As I began to consider my “maternity leave” I realized that I could quite possibly have a truly unique situation on my hands.

I work in private practice and my husband is an amazing stay at home Dad. We had been waiting to …