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.

Evidence based medicine at the expense of the art of medicine

Physician
May 23, 2010

Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at …

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Evidence based medicine at the expense of the art of medicine

Joint Commission hospital inspections have improved

Physician
May 22, 2010

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.

Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the …

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Joint Commission hospital inspections have improved

Ethics of futile care

Physician
May 21, 2010

The bioethics community has been working on defining the concept of medically futile care for more than a quarter of a century, yet the debate continues. The way in which the current notion of medical futility becomes folded into the proposed healthcare reform bills is at a critical point.

Sophisticated medical technology that is at once life-saving, life-prolonging as well as death-prolonging has created populations which, in the past, would have …

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Ethics of futile care

Defensive medicine starts early in residency training

Physician
May 19, 2010

Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients.

I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some …

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Defensive medicine starts early in residency training

Blood tests in hospitals may be unnecessary

Physician
May 17, 2010

I’ve just finished a month “on-service” as a teaching attending for a general medicine team here at GlassHospital. This means I served as the physician of record for every patient admitted to the team.

You might find it interesting to know that patients admitted to the hospital’s general medicine service get assigned to their teams by random assortment. Since there are five teams, one team takes call every fifth day. …

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Blood tests in hospitals may be unnecessary

Patient wants an apology, not money, after medical malpractice

Physician
May 16, 2010

by Tricia Pil, MD

This is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.

FRIDAY

Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of …

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Patient wants an apology, not money, after medical malpractice

Brainstorming other income opportunities for doctors

Physician
May 15, 2010

Once you’ve decided that you want to explore other income opportunities, then it’s time to do some preliminary brainstorming.

The goal here is to create a list of business ideas that you would find success in and be happy with. As a physician, you have a distinct advantage if your business plan involves the medical field. However, you do not need to limit yourself to this field as there are enumerable …

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Brainstorming other income opportunities for doctors

Endocrinologists may improve surgical care in diabetic patients

Physician
May 15, 2010

by Kristina Fiore

Shorter hospital stays and lower costs were the result when surgical patients with diabetes and dysglycemia received endocrinology consults, researchers said.

Adding endocrinologists to surgical care teams for patients with abnormal blood glucose readings cut total length of stay among patients in a single center by 1,342 days and saved the hospital $1.15 million, according to Arthur Chernoff, MD, of Albert Einstein Medical Center in Philadelphia.

Chernoff presented his findings …

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Endocrinologists may improve surgical care in diabetic patients

Medical practice success depends on a strong clinical team

Physician
May 13, 2010

Although every day can bring surprises in a medical practice, you can develop a clinical team that can optimize the efficiencies of your operation and make it easier for you to see your patients.

There are three key areas that lead to provider frustration in daily operations: preparation and anticipation; the daily dance; and being in the moment. Address these, and your days should go more smoothly.

Preparation and anticipation

Are your charts …

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Medical practice success depends on a strong clinical team

Outpatient internal medicine needs a consultant track

Physician
May 12, 2010

I have spent most of the past 2 weeks on the road – first at ACP and this week at SGIM. I have talked with many internists, but several conversations have contributed to writing this post. Each of several leaders contributed to these ideas, but I will keep them anonymous so the innocent are protected.

Here are the main assumptions:

1. Internists by training excel in the care of complexity
2. Pursuing the …

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Outpatient internal medicine needs a consultant track

ABIM: Quality medical care needs more than strong systems

Physician
May 10, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This clinic has no real computer system, …

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ABIM: Quality medical care needs more than strong systems

Children with fever may not receive antibiotics in the ER

Physician
May 10, 2010

by John Gever

Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.

A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.

Although …

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Children with fever may not receive antibiotics in the ER

False patient contact information worsens emergency care

Physician
May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

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False patient contact information worsens emergency care

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Medical malpractice deposition survival tips for doctors

Physician
May 9, 2010

An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.

by Ilene R. Brenner, MD

The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.

So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location …

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Medical malpractice deposition survival tips for doctors

Online dermatology visits for acne can be effective

Physician
May 9, 2010

by Chris Emery

Acne patients who received online treatment from dermatologists had similar outcomes to patients who were treated in the doctor’s office, a new study found.

Patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits, Alice J. Watson, MBChB, MRCP, MPH, of the Center for Connected Health in Boston, and colleagues wrote in the report, published online April 19 in the …

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Online dermatology visits for acne can be effective

Quality hospital care deserves to be celebrated

Physician
May 5, 2010

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and …

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Quality hospital care deserves to be celebrated

Malpractice fears influence cardiology decisions

Physician
May 4, 2010

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

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Malpractice fears influence cardiology decisions

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

Defensive medicine worsens patient care and raises costs

Physician
May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.

How does a fear of lawsuits increase costs? The most direct way is …

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Defensive medicine worsens patient care and raises costs

Money prevents patients from seeking timely heart care

Physician
May 3, 2010

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

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Money prevents patients from seeking timely heart care

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