KevinMD.com

Being good doctor requires bearing witness

Physician

September 23, 2013

I was naive when I decided to enter medicine. My impressions then were that doctors always “did” stuff — for patients, and to patients. We would do stuff to you (examinations, blood tests, scans, surgeries) in order to help you.

A lot of time and education later, I’ve learned that that straightforward paradigm is far from the only way that doctors help people. In fact, following that mostly simple formula (you come to us, we do stuff to …

Hospice also saves the doctor

James C. Salwitz, MD

Physician

September 23, 2013

You are taking care of a patient with metastatic pancreatic cancer. The disease has spread, surgery is not an option and second line chemotherapy has failed. He is in pain, but is poorly compliant with narcotic directions. He keeps falling down the stairs. His wife cries all the time. The family is desperate for help. The patient is in the office with loved ones, looking for guidance.

“What do we do …

Read more…

Hospice also saves the doctor

With the patient hemorrhaging, doctors are backed into a corner

Jordan Grumet, MD

Physician

September 23, 2013

We were pretty damn lucky that she was young and healthy.

The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.

It was a routine hysterectomy. None of the pizazz and flare of a gynecology-oncology surgery, but …

How I almost missed a patient’s incredibly powerful story

StorytellERdoc, MD

Patient

September 23, 2013

He was an ornery kind of fellow, evident by his scowl and beady, glaring eyes that greeted me upon my entrance into his room. The nurse, thankfully, had given me a heads-up on this eighty-five year-old gentleman’s demeanor. With her kind warning, I felt prepared to be tested by this patient’s demanding and abrupt nature.

What I wasn’t ready for, though, was this man’s physical appearance. He was extremely small in …

How can we revise the patient medical record?

Fred N. Pelzman, MD

Physician

September 22, 2013

So what exactly do we want a patient-centered medical record to look like?

What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.

If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …

Who will pressure physicians to join the 21st century?

Robert Pearl, MD

Physician

September 22, 2013

A Bank of America ATM can figure out who you are and how much money is in your account in seconds. It can spit out cash in virtually any currency from nearly any spot in the world — even if you’re a Chase customer. It’s a technological convenience we’ve all come to expect.

Hospitals and doctors’ offices are starting to replace hard copy patient records with computerized heath systems. Some U.S. …

The horror and beauty of performing an amputation

Sid Schwab, MD

Physician

September 22, 2013

There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.

Stark and …

We need health care instead of disease management

Robert G. Dorfman

Patient

September 22, 2013

I always wanted to become a medical doctor to cure the sick and save lives. In fact, most doctors I know chose the profession for the same reason. This fundamental desire among physicians to treat patients is because our beliefs have been deeply rooted in the concept of disease management rather than the provision of health care.

As an aspiring physician and student of health care, I often catch myself heading to …

What happens to patients after their doctors die?

Abraar Karan, MD

Patient

September 22, 2013

Several studies have explored the experience of grief that physicians feel when they lose a patient. But what about when the patient loses a physician — when the doctor dies?

Dr. K was a well-known child psychiatrist, a loving husband, a father of two, and an irreplaceable support and friend for a number of children suffering from trauma, schizophrenia, bipolar disorder, autism and other challenging psychiatric conditions. Earlier this year, …

Medical societies’ role in improving leadership in medicine

Suhail Raoof, MD

Medical Education

September 22, 2013

The greatest good you can do for another is not just to share your riches but to reveal to him his own.
– Benjamin Disraeli

In 2009, when I was president-designate of the American College of Chest Physicians, a prominent physician, educator and outstanding mentor, who had recently died was honored by her colleagues. One of her junior colleagues, who had never met …

What to do after you make a medical error

Brian J. Secemsky, MD

Physician

September 21, 2013

Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.

Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …

The hidden cost of free EMR systems

Elizabeth Hipp

Health Technology

September 21, 2013

Electronic health records (EHR) systems are expensive. Really expensive. In fact, there have been reports of these systems causing significant revenue decreases or business interruptions — such as Henry Ford Health System in Michigan reporting that implementing EPIC was a direct cause of their 15 percent net income decline in 2012. Using a free EHR system is a tempting alternative for many independent doctors or small practices. But are there …

Read more…

The hidden cost of free EMR systems

After a Creutzfeldt-Jakob exposure, should patients be told?

Timothy Lahey, MD

Conditions and Diseases

September 21, 2013

Recently we have learned that 15 patients in New England were exposed to a rare infection called Creutzfeldt-Jakob disease (CJD) when neurosurgical instruments contaminated with the infection were used in their care. Each had undergone a brain or spinal surgery in early 2013, and now their future was uncertain.

Creutzfeldt-Jakob disease is caused by an infectious agent called a prion — as is “mad cow disease.” Originally discovered in the brain-eating Fore cannibals of Papua New …

Necrotizing fasciitis: A case study and discussion

Adam Bitterman, DO

Conditions and Diseases

September 21, 2013

Necrotizing fasciitis is a rare but life-threatening soft tissue infection. Its presentation is characterized by rapidly spreading inflammation and resultant death both of the surrounding soft tissue and fascial planes. Prompt recognition and aggressive treatment is paramount in order to avoid fatality. Often times, symptoms may overlap in their presentations so one must maintain a high index of suspicion and a multidisciplinary approach facilitated appropriate imaging studies and resulted in a …

Why I love my job as an emergency physician

Brian Drummond, MD

Physician

September 21, 2013

Walking into each room to greet my next patient often reminds me of Forrest Gump: “You never know what you’re going to get.” It’s challenging to have only one chance to get it right but I love being an emergency room doctor.

Today, an older lady has slipped at home and she’s taped to a hard backboard with a rigid neck collar in place. It’s routine for all patients involved in …

MKSAP: 47-year-old woman with severe fatigue

mksap

Conditions and Diseases

September 21, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 47-year-old woman is evaluated for a 6-month history of severe fatigue in the afternoon that is often disabling. The patient has a 15-year history of multiple sclerosis. She states that her mood is good and that she is not feeling depressed or sad. She describes no problems with her sleep, and her partner …

My patient experience wasn’t an outlier

Ashish Jha, MD, MPH

Physician

September 20, 2013

On a warm and sunny August Sunday, I was rollerblading with my kids on the Shining Sea Bikeway. On mile nine on the trip, I hit a tree root, went flying, and landed on my shoulder. I could tell immediately that something was wrong — I couldn’t move my arm and was in the worst pain of my life. Feeling for my left shoulder, it was obvious that I had …

Read more…

My patient experience wasn’t an outlier

Balance bedside assessment with high-tech testing

Hans Duvefelt, MD

Physician

September 20, 2013

My new glasses were years overdue. The eye doctor understood perfectly my request that the focal point and pupillary distance for my iPad reading glasses had to match my habitual reading style – right under my nose. The result couldn’t be more pleasing.

The other day my wife squinted over her iPad and said “I don’t know if I’m getting a cataract or if I just need new glasses. My right …

Would every profession consent to returning fees for mistakes?

Michael Kirsch, MD

Physician

September 20, 2013

Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …

This is the grim reality of starting a private primary care practice

Davis Liu, MD

Physician

September 20, 2013

She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.

So …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts