I talk a lot with different physicians about integrating NP/PA providers into their practice. I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians. Many times a doctor will have a medical “horror story” with the NP/PA playing the villain. One bad encounter or event seems to justify a complete rejection of the many positive …
5 ways to ease the integration of NPs and PAs
Pamela sits on the examining-room stool, looking at me expectantly.
I am in my first year of medical school. I do as I’ve been told to do in medical skills class: I observe my patient — without judgment or assumptions — and try to figure out what questions to ask, based on the information I am given.
Pamela has curly, strawberry-blonde hair and looks to be thirty, just a few years older …
Interviewing people is hard: A medical student keeps trying
As people select health insurance during open enrollment, what many don’t realize is how the creation of the health insurance exchanges or health insurance marketplace via the Affordable Care Act (a.k.a. Obamacare) will ultimately result in Americans becoming less healthy and more insolvent. Let’s review the pros and cons.
Although the Affordable Care Act provided important benefits of expanding and ensuring coverage with preventive benefits, insurability of all regardless of prior …
Health reform will make us less healthy and more insolvent
The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I’d say that a sizeable number of physicians that I work with are towards the latter end of the spectrum.
I find that these doctors, typically over the age of 50, are struggling the most to keep …
Glory days: Is a golden age of medicine on our doorstep?
Life is full of choices and each choice has the potential to open certain doors and close others. I choose medicine. It is a demanding career, but even as a 7th grader, I knew what I was signing up for.
What I didn’t know was how much this profession could influence the trajectory of my personal life and the types of relationships I’m able to maintain. I grew up genuinely thinking …
Serving two masters: Balancing medicine and family
Like most second-year medical students, I have the MP3 files of Goljan’s high yield pathology review lectures on my phone. Unlike most medical students, I rarely bring myself to listen to them, always opting for their Motown or punk counterparts instead. I often feel guilty about this — listening to them would make for more efficient car rides and walks home — …
In the midst of a lumbar puncture: Thinking of Stevie Nicks
My journey in the specialty of family medicine started in 2004 during my third year family medicine clerkship. I was assigned to an office located in the southwestern town of Yauco, Puerto Rico. The practice had two providers who saw patients of all ages. My family medicine attendings made me appreciate the way our specialty approaches patient care. We treat our patients taking into account their psychosocial framework and partner …
We do not need to redefine the role of family physicians
A few months ago I was paged by a medical student in the emergency room at ten o’clock. I had just changed my clothes, and before my pager went off my attention had been squarely fixed on the newest Jack Reacher novel.
You can usually tell when someone is going to ask you to come into the hospital from home, because there …
Medicine cannot be reduced to just a job. Here’s why.
Brittany Maynard has passed from this life. This brave but unfortunate 29-year-old woman with incurable progressive brain cancer drew public attention by choosing to go public with her choice about end of life care.
“Brittany suffered increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms,” according to a statement Sunday night from Sean Crowley, spokesman for Compassion & Choices, a national nonprofit working to …
Brittany Maynard: It’s more than death with dignity
A version of column was published in USA Today on September 14, 2014.
The public can rate and review most things today: books, hotels, and restaurants, to name a few. Even doctors. There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much …
The highest rated doctors may not provide the best care
An excerpt from The Public Physician — Practical Wisdom for Life in a Connected, Always-On World.
What you do, where you live, and what you intentionally create as a physician in public should be determined by what you want to accomplish. What are you trying to get done?
Perhaps you want to …
Every physician is public and has an audience
Would you base a life or death decision based on one doctor’s opinion? One research article? Google searches? What would it take?
I recently read that Brittany Maynard took her own life. Plagued by glioblastoma, she chose to reject chemotherapy, radiation, and hospice. Tomorrow, I have a schedule packed with glioblastoma patients who personify courage, determination, and faith.
Glioblastoma (GBM) …
Does Brittany Maynard’s decision affect the future of oncology?
Where are all the physician digital health innovators?
This is a question I hear all the time from people working in, researching and observing the fast-moving health technology arena.
The general thinking is that physicians are not involved enough in digital health — and it shows. Over the past year, I’ve been making it a point to talk with people from around the world, including doctors, about their perceptions of digital health.
Physicians …
What’s your physician digital health innovator type?
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The practice of medicine and health care in general has become an electronic and increasingly mobile interaction. Patients are better informed, more engaged, more connected and have a much greater virtual presence. In fact, according to Pew Research, the fastest growing demographic on Twitter are those who are in the 45 to 65 age bracket. Nearly 50 percent of all …
Apple Watch and HealthKit: A new age of virtual health care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis. He has had progressive pain in his left knee with activity, which limits his ability to hike. The patient has similar pain in the right knee, but it …
MKSAP: 66-year-old man seen for a preoperative evaluation
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
When you walk into any physician’s office or hospital, computers are everywhere. By 2013, nearly 70 percent of hospitals had moved away from paper charts and toward electronic health records, or EHRs, and more are making …
Your electronic health record may lack vital information
There is abundant evidence for malaise in the physician workforce, but little agreement about etiology, treatment options, or prognosis. As a senior physician who still has a lot of involvement with physicians of all ages, I want to propose an etiologic framework. Perhaps if we agree on etiology, we can look at treatment options.
There are three ways to look at what doctors do: the artisanal, the economic, and the scientific. The …
A framework for physician malaise
I was recently injecting anesthetic into a boil for incision and drainage. The abscess swelled and returned an arcing spray of lidocaine laden with blood and pus, soaking the thigh of my cotton scrub pants. A cheap plastic gown would have protected me — I usually wear one. But I couldn’t find one and had other tasks waiting. My mind went to Ebola and exposed nurse necks.
What if this were …
The people treating Ebola patients should be volunteers
We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging. Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the …
The era of trial and error medicine needs to be over
Ironically, we had just finished our endocrine unit when I noticed a lump in my neck. Perhaps school had made me more vigilant, or perhaps I merely fell into the realm of hypochondriac medical student, but I couldn’t ignore this lump.
I set up an appointment with my doctor fully expecting a diagnosis of medical student neuroticism. Instead she agreed that it was …
A medical student diagnosed with cancer
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