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.

Primary care access isn’t guaranteed by health insurance

Physician
March 26, 2010

An excellent article appeared recently in the Washington Post, entitled, “Having health insurance doesn’t ensure it will be easy to find a doctor,” where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her.

“I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors …

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Primary care access isn’t guaranteed by health insurance

ED can predict heart death

Physician
March 24, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found.

In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen …

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ED can predict heart death

Palliative care shows the importance of language

Physician
March 23, 2010

by Patrice Villars

The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication.

What if, in our kind, well-meaning …

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Palliative care shows the importance of language

Futile care has human and financial costs

Physician
March 22, 2010

I haven’t ever saved a life. No doctor has. We may prolong the inevitable, but we don’t save anyone. We aren’t immortal, and weren’t meant to be. We die. All things do. Plants, animals, even stars. Death is as much a part of life as birth. And yet, at times people chase medical science as if we have immortality in all our gadgets and pills.

Why am I writing this?

A few …

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Futile care has human and financial costs

Professionalism matters in correctional health care

Physician
March 19, 2010

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …

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Professionalism matters in correctional health care

Dance healed this physician and helped with burnout

Physician
March 18, 2010

Ten years ago, I was an Emergency Medicine Resident and wanted to die. Today, I’m a general practitioner in part-time practice and am in love with life. What made the difference? I signed up for a dance class.

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level – even …

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Dance healed this physician and helped with burnout

Primary care needs to be valued first before it can be saved

Physician
March 9, 2010

I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen.

One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.”

Clearly the insurance …

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Primary care needs to be valued first before it can be saved

Helping organ donation with donor advocate teams

Physician
March 8, 2010

One of the joys of practicing at an academic center is that I get to do many different things in my job.

The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice.

Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses …

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Helping organ donation with donor advocate teams

Why physicians are working fewer hours

Physician
March 8, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed.

After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues.

The decline coincided …

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Why physicians are working fewer hours

Using CT scans to diagnose chest pain in the ER

Physician
March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

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Using CT scans to diagnose chest pain in the ER

How doctors allow bias to affect patient care

Physician
March 5, 2010

Part three of a series. See also parts one and two.

Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them.

Here’s what negatively influences a doctor’s decision making:

1. They fall behind in clinic. Your doctor may be naturally …

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How doctors allow bias to affect patient care

Becoming vegetarian can help fight high cholesterol

Physician
March 5, 2010

I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a …

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Becoming vegetarian can help fight high cholesterol

Hospitals can deliver low cost, high quality care

Physician
March 4, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Many hospitals that spend relatively little per patient deliver good-quality care, researchers said.

Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment of pneumonia or congestive heart failure (CHF) did not have markedly lower readmission or risk-adjusted mortality rates than hospitals in the lowest …

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Hospitals can deliver low cost, high quality care

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How patient comments will affect your physician practice

Physician
February 27, 2010

Originally published in HCPLive.com

by Owen Dahl and Altamash Rahman

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when …

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How patient comments will affect your physician practice

The Haiti earthquake and its broken health infrastructure

Physician
February 27, 2010

Dr. Barth Green co-founded Project Medishare, which has worked in Haiti for two decades. He led the first team of U.S. physicians to Port-au-Prince after the earthquake and, together with the University of Miami’s Global Institute, spearheaded the development of a 240-bed tent hospital that is now the country’s largest functioning urgent care hospital. His group is working with the U.S. government to establish Haiti’s first rehabilitation hospital. Green …

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The Haiti earthquake and its broken health infrastructure

How patient satisfaction scores can affect physicians

Physician
February 26, 2010

I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar.

That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in …

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How patient satisfaction scores can affect physicians

Can doctors learn medicine from physician lounges?

Physician
February 25, 2010

I just finished rotating at a community hospital where one of the most interesting things I’ve enjoyed is stopping by the Doctor’s Lounge. I can always count on a getting coffee there and hearing some good conversation – doctors asking for input on interesting cases, laughing, sharing stories, both personal and professional, and catching up on each other’s busy lives. In fact, I ran into an old friend of mine …

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Can doctors learn medicine from physician lounges?

Value doctors as listeners to prevent primary care burn out

Physician
February 25, 2010

A recent editorial in the Boston Globe addressed the dearth of primary care physicians. The piece concluded: “Federal funding for new residency slots should follow reforms that address the underlying reasons – principally money – that lead doctors to choose to specialize.”

Money is certainly important. But there is another obstacle to attracting primary care doctors that is more subtle, though perhaps equally important. Consider the following story.

Recently I had …

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Value doctors as listeners to prevent primary care burn out

Atul Gawande’s The Checklist Manifesto reviewed

Physician
February 24, 2010

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

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Atul Gawande’s The Checklist Manifesto reviewed

Some hospitals tube feed patients with advanced dementia

Physician
February 23, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Tube-feeding patients with advanced dementia — a practice whose effectiveness has been questioned by two widely cited literature reviews — is most common in larger hospitals and those run for profit, researchers said.

The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater …

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Some hospitals tube feed patients with advanced dementia

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