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.

How the ER is now used to triage every patient

John Schumann, MD

Physician

February 22, 2010

The ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ? …

Laparoscopic procedures injure the surgeons that perform them

Kevin

Physician

February 19, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.

More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the …

Texting and cell phone use are becoming more common in hospitals

Edwin Leap, MD

Physician

February 18, 2010

The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s …

Doctors are responsible for a minority of medical mistakes in radiation therapy

Amy Tuteur, MD

Physician

February 11, 2010

The New York Times recently featured a disturbing expose of serious medical errors associated with the newest forms of high tech radiation treatment, entitled, Radiation Offers New Cures, and Ways to Do Harm. The piece is an example of excellent medical journalism, compelling stories of two individuals who sustained truly horrifying injuries as the result of treatment errors framed a detailed investigation of similar errors that have occurred in New …

How will the earthquake affect the future of the Haitian American community?

Erin Marcus, MD

Physician

February 10, 2010

Marleine Bastien is the founder and executive director of Fanm Ayisyen Nan Miyami–Haitian Women of Miami–www.fanm.org, which advocates for the rights of Haitian women. She is also a congressional candidate for U.S. House District 17, representing Little Haiti and other neighborhoods in Miami. Erin N. Marcus spoke with Bastien on Jan. 22 about the Haiti earthquake.

What has FANM been doing since the earthquake?

As soon as we heard about it, …

When doctors are at greatest risk of making a mistake

Dr. Martin Young

Physician

February 5, 2010

Early in my training as a glider pilot my instructor showed me an excellent but simple analogy for ensuring my safe performance as a pilot. I have always remembered this lesson, which he called the ‘accident slope’, and have tried to apply it to my method of practicing medicine, as well as the other ‘dangerous’ activities for which I have an affinity.

“Accidents and mistakes are seldom the result of one …

Why primary care doctors need to practice insurance free medicine

Matthew Mintz, MD

Physician

February 3, 2010

I never thought I would be in academic medicine for so long.

When I was hired about 12 year ago, I figured I would stay in academics for a few years and then join a private practice Internal Medicine group. Now, I can’t even fathom that idea. One of the reasons I have stayed at my institution for so long is that I love teaching and the academic environment.

However, a second …

How soon should the dead be buried in Haiti?

Kevin

Physician

February 3, 2010

Originally published in MedPage Today

by Crystal Phend

Aid appears to still be trickling in to Haiti, making little headway against the swelling need for food, water, and medical care after last Tuesday’s earthquake.

With a projected death toll between 100,000 and 200,000, the dead bodies piled in the streets — and reportedly even being incorporated into roadblocks by angry Haitians …

How to stop theft from your medical practice

Kevin

Physician

January 27, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

There’s a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn’t know anyone who could get through the day without two or three juicy rationalizations. That may be true. But when a rationalization involves taking things from the ofﬁce or workplace, and that ofﬁce just happens to …

How should patients decide which hospitals are best for them?

Zackary Berger, MD, PhD

Physician

January 26, 2010

Johns Hopkins Hospital is consistently named one of the best in the country. I can’t disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other …

Teaching doctors the art of negotiation

Kevin

Physician

January 22, 2010

Originally posted in HCPLive.com

by Jeff Brown, MD

When I am in a civilian situation and someone asks me what I do, if I am feeling whimsical, I sometimes answer “I’m in sales.”

Think about it – almost all of our professional interchanges can be seen as: 1) trying to talk someone out of doing something, like smoking, or 2) trying to talk someone into something, like exercising. Using a broader brush, you …

Read more…

Teaching doctors the art of negotiation

Primary care needs a face lift, and a better agent

Jennifer Adaeze Anyaegbunam

Physician

January 21, 2010

General medicine is not sexy. Less than a fourth of the doctors in the United States are currently primary care providers like Pediatricians, Ob/Gyns, and Internists. According to a recent study published by the Journal of the American Medical Association, only 2% of medical students intend on pursuing a career in general internal medicine. So when health-care reform becomes a reality, and the 46 million uninsured men, women, and children …

Why scaring patients to quit smoking may not be effective

Kevin

Physician

January 20, 2010

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Telling people about the benefits of quitting is more likely to help smokers break the habit than scaring them with the dangers of continuing, researchers found.

Callers to a tobacco quitline were nearly twice as likely to stop in the short term when they got positive messages rather than …

A doctor writes about his first day in Haiti

Kevin

Physician

January 19, 2010

by Jonathan Crocker, MD

From Cange, Central Plateau
Haiti
01-18-10

We arrived at Cange, in the Central Plateau, the heart of operations for Partners In Health/Zamni Lasante, yesterday. As we expected, things are incredibly busy. People are still arriving from Port au Prince. Those who have been fortunate enough to survive their injuries this long are now running into complications of wound infections, some of which have turned septic, and venous blood clots (from …

Tips for doctors who negotiate reimbursement rates with insurance companies

Kevin

Physician

January 19, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payor and then, for whatever reason, just file it away. Most medical groups do not have a good, proactive methodology …

How root cause analysis can improve patient safety

Robert Wachter, MD

Physician

January 19, 2010

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Analysis enterprise on steroids. This is what we did at UCSF Medical Center, and it was the most important change we’ve made in our safety journey. Here’s the story, …

Scenes from Haiti before the earthquake, and what the future holds

Kevin

Physician

January 18, 2010

Originally published in MedPage Today

by Michael Smith

I remember walking through the squalid downtown of Port-au-Prince and coming across a woman sitting by the roadside selling carefully washed tin cans. That was how she made her meager living.

There were scenes that were more appalling — a man on a street corner with his head split open by a machete, a corpse …

Good doctors sometimes may make patients unhappy

Edwin Leap, MD

Physician

January 18, 2010

Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. …

How doctors can look for the right non-clinical medical job

Joseph Kim, MD, MPH

Physician

January 17, 2010

How many physicians do you know who have chosen to leave their clinical practice?

There’s no doubt that physicians are getting burned out. Many are tired of fighting insurance companies and even more physicians are getting discouraged about reductions in reimbursement. This has caused some physicians to drop Medicare and Medicaid. Others have switched to cash-only or concierge/boutique practice models. Then you have your group of physicians who have simply decided …

How bad patient outcomes affect physicians

Shantanu Nundy, MD

Physician

January 16, 2010

Ms. FR didn’t look so great even when I first met her. She had been admitted to the hospital three times in past 6 weeks for nausea/vomiting and generalized malaise. While the cause of her acute illness was not entirely clear, we suspected that her widely metastatic breast cancer had something to do with it.

By the time I met her she had already been in the hospital for 1 week. …