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.

Medical malpractice reform by President Obama and the White House

Emily P. Walker

Physician

September 19, 2009

by Emily P. Walker, Washington Correspondent, MedPage Today

The White House today announced details of a $25 million grant program to test alternatives to the tort system for medical liability cases.

In his Sept. 9 speech before Congress, the president announced he would direct Kathleen Sebelius, Health and Human Services secretary, to launch pilot programs meant to cut down on physicians …

Violence in the emergency department and how to promote ER safety

Kevin

Physician

September 12, 2009

by Patricia B. Allen, MBA, RN

What would you differently tomorrow if you had a violent episode in your emergency department today?

Violence in the ED is a growing and alarming phenomenon. A recent survey conducted by the Emergency Nurses Association (ENA) revealed that 25 percent of the RN respondents report experiencing physical violence more than 20 times in the past three years and 20 percent of the respondents revealed encountering …

A patient dies after doctors fail to communicate in the operating room

Kevin

Physician

September 10, 2009

by Jerry I. Meyers, Esq.

Communication is essential between health care providers but sometimes communication fails because of the arrogance or carelessness of the persons involved in the needed medical communication.

Several years ago, a female client about to enjoy an important anniversary was admitted to a University affiliated hospital for the purpose of having a colostomy wound debrided.

This was to be a one-day inpatient hospital procedure and was associated with little …

Does being on the America’s Best Hospitals list affect patient outcomes?

Charles Bankhead

Physician

September 4, 2009

by Charles Bankhead, Staff Writer, MedPage Today

A news magazine’s rankings of top-rated hospitals for heart failure care did not include many hospitals that performed at least as well as the ranked centers, according to a comparison of the magazine’s list and government data.

Hospitals that made the U.S. News & World Report list had a better 30-day mortality than …

How hospitalists can provide high quality patient care at the lowest possible cost

Robert Wachter, MD

Physician

September 3, 2009

Much has been made of the superior performance – on both cost and quality – of integrated health care organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated history, few believe that the rest of us – namely the docs and hospitals that provide the bulk of American health care – can quickly achieve such seamless …

Is alternative health a form of fundamentalism?

Amy Tuteur, MD

Physician

September 1, 2009

There once was a time when all food was organic and no pesticides were used. Health problems were treated with folk wisdom and natural remedies. There was no obesity, and people got lots of exercise. And in that time gone by, the average lifespan was … 35!

That’s right. For most of human existence, according to fossil and anthropological data, the average human lifespan was 35 years. As recently as 1900, …

Are relationships being lost in medicine, and are hospitalists partly responsible?

Edwin Leap, MD

Physician

August 29, 2009

An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.

See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them …

Will medical malpractice reform be included in the final health bill?

Jeffrey Segal, MD, JD

Physician

August 27, 2009

Believe it or not, some element of federal tort reform is not only possible, but likely.

Sounds counterintuitive? We all know that Congress has a strong majority with Democrats. We know the President is also a Democrat. We know the plaintiff’s bar strongly supports the Democratic Party. We know that Democrats have traditionally shied away from specific reforms, such as caps on pain on suffering. So, this would seem the worst …

Will nurses solve the primary care crisis?

Kevin

Physician

August 23, 2009

by Derek Mazique

Between “death panels,” a NICE-style cost effective analysis board, and Obama’s slowly graying hair, one conspicuously absent part of reform are reimbursement rates. Medicare and private insurance typically reimburse for expensive procedures, which ultimately rewards procedure-heavy specialists while discourage those cognitive-heavy services like primary care docs.

The result? As a recent Baltimore Sun op-ed and this very blog pointed out, a combination of pay and burn-out are encouraging …

A doctor in Cuba becomes a nurse in the United States

Kevin

Physician

August 20, 2009

When physicians in other countries come to the United States, they often become nurses or lab technicians, rather than re-taking rigorous board exams to remain doctors.

One example includes doctors from Cuba. According to this story in The New York Times, “6,000 medical professionals, many of them physicians, have left Cuba in the last six years.” Cuban doctors, who often earn $25 per month, find it significantly more …

The consequences of doing everything in end-of-life-care

Marya Zilberberg, MD, MPH

Physician

August 19, 2009

Fear-mongering about health care reform killing grandma really burns me: I have delivered “everything”, I know what “everything” looks like. I know its dark side. I also know that these deliberate and self-serving lies will ultimately hurt not only grandma, but the rest of us too. Here is what I mean.

When I was in practice I cared for critically ill patients. I loved the ICU for its complex physiology and …

How to fix the primary care shortage

John Horstkamp, MD

Physician

August 17, 2009

The primary care physician (PCP) shortage has attracted a lot of attention recently, and for good reason. Individual Americans are concerned that they will not have timely access to needed medical care, and policy makers are concerned that our specialist-heavy medical system is failing, giving us expensive but disjointed, poor quality care. Many experts rightly think that a robust primary care system would give us better health care for …

Read more…

How to fix the primary care shortage

Robert Ricketson and the surgical screwdriver medical malpractice case: The medical records revisited

Kevin

Physician

August 11, 2009

Robert Ricketson is a spine surgeon who was involved in a high profile 2003 medical malpractice case in Hawaii where a surgical screwdriver was implanted into a patient’s back. This is his account of the ordeal.

by Robert Ricketson

I am writing today out of frustration and anger, as I am frankly quite tired of passively going along as my name appears year after year in malicious “medical blogs” and …

Will the lack of primary care doctors make universal coverage useless?

Kevin

Physician

July 23, 2009

It appears that one source of agreement among health reformers is that there isn’t enough primary care doctors.

The New York Times wrote a front-page piece on this issue last month, which I had commented on. Now, an article in the Washington Post re-iterates the same theme:

As the debate on overhauling the nation’s health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are …

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Will the lack of primary care doctors make universal coverage useless?

ACP: A practice model for increasing the appeal of General Internal Medicine

American College of Physicians

Physician

June 1, 2009

The following is the first in a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Much is written and discussed these days about the importance of care coordination by a primary care physician, not only to facilitate patient-centered quality of care, but also to curb the unsustainable growth in the nation’s health care tab. Yet, we hear that the current shortage of …

How much time do doctors spend on paperwork?

Kevin

Physician

May 29, 2009

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

6 top medical comments, May 10th, 2009

Kevin

Physician

May 10, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether emergency physicians best served to staff urgent care centers:
As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is …

Read more…

6 top medical comments, May 10th, 2009

How the primary care doctor shortage threatens Obama’s health reform plan

Kevin

Physician

April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

Edwin Leap: Who pays when politicians commit malpractice?

Edwin Leap, MD

Physician

April 2, 2009

My kids love to play Monopoly. They delight in acquiring properties, making money and crushing their siblings. They play with passion and savagery. That is, until recently. A couple of weeks ago I walked past the Monopoly board, spread on the floor between my children and their dear friend Tyler.

“˜How’s it going guys?’

“˜Great game, but we all ran out of money. So, we just put some more money on the …

Most hospitalists are good, but some, like these ones, aren’t

Kevin

Physician

April 1, 2009

It’s a well known phenomenon that hospitalists are taking over inpatient medicine.

And no wonder, the payment system strongly discourages newly minted doctors to practice outpatient medicine, and the demand that hospitals have for inpatient physicians is surging at an unprecedented rate.

It’s a good time to be a hospitalist, but, as this reader writes to me, that may lead to an increasingly variability in the quality …