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.
A quote by Sir Winston Churchill: “However beautiful the strategy, you should occasionally look at the results.”
Actually, Churchill never said this. It may have been Ian Gilmour, a member of Margaret Thatcher’s Cabinet, years after Churchill’s death. Nevertheless, this quote is often cited in the context of risk management. It is as relevant in a medical malpractice lawsuit as it is a warning to malpractice attorneys. No matter how elegant …
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How flawed legal reasoning can tilt medical malpractice cases
When I’m not knocking on exam-room doors as a pediatrician in New York City, I’m knocking on voters’ doors in Northampton, Pennsylvania—a small county that could determine the outcome of this year’s nail-biting presidential election.
Each time I walk up to a voter’s front door, my heartbeat quickens. You would think a doctor who talks to total strangers every day would be immune to such jitters. But even with a door-knocking …
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As a doctor, what I learned from knocking on doors for the presidential election
My first ICU rotation of intern year was filled with great darkness. It was dark outside as I walked from my car into the hospital each morning before sunrise, and it was again dark when I walked to my car at the end of the day. Less than one hour into my first day in the ICU, a patient’s weak and ineffectual heart stopped beating, and CPR was swiftly initiated. …
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From darkness to empathy: How one ICU patient transformed my perspective
Eight female nurses at a United Kingdom hospital are suing their employer for not assuring their psychological and physical safety. The nurses work in specialized areas that require their changing uniforms once daily. There is a trans-female nurse, similarly specialized, who changes with them. He wanders about the locker room in briefs or nude, the women report, ogling them as they exchange clothing. It has also been related that he …
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Nurses sue over trans colleague’s actions
As physicians, we are often collectively gaslit—made to believe that somehow, we are responsible for system failures. Many physicians are brainwashed to “drink the Kool-Aid” and accept phrases like, “This is the way things have always been done.” We are made to feel inhuman when we advocate for ourselves as if we are somehow to blame. The system uses terms like “unprofessional,” “unable to cope with the rigors of being …
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Physician gaslighting looks like this
A million vulnerable patients have died in the last decade, and while I have no doubt the rate of overdose and poisoning will drop nationwide—killing a million vulnerable patients has that effect eventually—I choose not to contribute to that death rate. This decision is in accordance with my deeply held beliefs. In 2014, Governor Asa Hutchinson signed the Arkansas Conscience Protection Act into law, supposedly protecting health care professionals who …
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Medical crisis or government overreach: How misguided policies are destroying lives
As health care predictive algorithms, including the Prescription Drug Monitoring Programs (PDMP), expand their reach beyond traditional enforcement of health care regulations, the concept of a social credit score has emerged as a powerful but controversial tool. Like predictive policing, social credit scores use an individual’s behaviors, online activity, and social interactions to assess their perceived trustworthiness and risk to society and are used as fodder for the prosecution of …
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The role of social credit scores in the enforcement of health care regulations
There’s a patient who comes to see me every week. Every time we part ways, I say, “OK, Susan (name changed)! See you in a month!” But inevitably, she’ll call on a morning when she knows I’m in the office, and my staff will fit her in. She likes to tell me about what she did with her granddaughter that week. She doesn’t have anything terribly wrong with her; she …
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Why in-person care still matters in the age of telemedicine
I am a person—a person with hopes, dreams, fears, and a favorite color. I am just like anyone else, trying to find my place in this world. Yet you only see me as a nuisance. I am always in your way, you say. I am an idiot. My existence is like a personal insult to you—and you never miss a chance to show it.
I was once a bright-eyed child full …
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How cruelty destroys: the unseen struggles of medical professionals
The COVID-19 pandemic was war, and I served in a foxhole. I survived, in part, by drowning my sorrow in song—music I abused as if it were drugs. I heard “Spaceman” by Nick Jonas today while driving to the hospital, and, at the peak of the chorus, dopamine surged in my brain, making me queasy. My neck hair stood up, and I went clammy. This was not a monstrous rush …
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A doctor’s pandemic playlist
I’m primary care and I see a patient in a 10-minute appointment who tells me she now has a disabled daughter who is 22, had a stroke, and currently cannot cope with all that her disrupted life is demanding of her. I am also expected to fill out that FMLA paperwork for that patient and respond to 20 back-and-forth portal messages on that same patient over the next two days, …
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The overwhelming reality of primary care: Why doctors still persevere
Ecclesiastes was probably written by many ancient scholars, although Jewish tradition holds that it was written by King Solomon. Whatever the provenance, I think the first chapter holds a nugget of wisdom that we need to try hard to remember:
What has been is what will be,
and what has been done is what will be done; there is nothing new under the sun.
Is there a thing of which it is said,
“See, …
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The enduring cycle of violence: lessons from history’s darkest moments
I had a dismal start to the second year of my psychiatric residency, and my subpar performance was noted by many faculty members. One professor approached me and told me to discuss the situation with my psychotherapy supervisor, adding, “Don’t let your supervisor sugarcoat it.” The professor knew that my advisor was an extremely kind and gentle person who would prefer to leave out the details of my performance so …
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The growing discrepancy between health care promises and practice
I miss my stethoscope—the small black one with the tiny neonatal head. I wore it around my neck constantly while on duty in the NICU and L&D. It served as an outward symbol of my knowledge and experience. Inwardly, it reminded me of all the things I could detect about a baby by simply looking, listening, and gently touching. My little stethoscope was ready in any emergency. It helped me …
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Early retirement may not be the solution to your burnout
In December 2019, I reached out to the grief counselors at the hospice organization that cared for my mother as she passed. It had been almost a year since her death, and I was running out of time to seek help. I had spent so much energy ensuring my daughters were OK, believing, as I was taught in medical school, that grief just passes. Back then, I learned grief lasted …
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Refill your cup to pull yourself back from the ledge
