Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
Don’t forget to manage your patients’ dignity
I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night.
So, what’s harder: medical school or law school?
Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training.
The other most …
Doctor by day, law student by night
Dear lawyers:
You got it right. Your operations make sense. I know this is wrong for me to say — doctors and lawyers are often at odds with one another — but I have to tip my cap here. I have this unsettling feeling that — from a professional standpoint — your billing practices make sense. And the way you do your documentation also makes sense. Your delegation and hierarchy make …
Lawyers have figured out what doctors haven’t
One of my favorite scenes in the recent Apollo 11 IMAX film was a dramatic panning shot of mission control moments before lift-off. Row after row of mission specialists, engineers, astronauts, communications technicians — all looking ahead in silent, unbreakable focus. All 100 percent dedicated to the three men about to lift-off into history. It was a truly mesmerizing portrait of teamwork.
While astronaut safety is the focus of every individual …
From a neurosurgeon: You need a family doctor
I recently read an article called “Inefficiency and luxury” in which the author stated that he has never tried to get any frequent flyer rewards, and in fact doesn’t even have a frequent flyer number. This statement left me a bit confused when I first read it. I’m not one who likes to leave money lying on the table. Then he …
A physician’s guide to frequent flyer rewards
What is your gut reaction when you hear the words “hospital chaplain?” Maybe it’s an eye roll or confused stare about what you believe to be an incoming attempt at religious conversion. As a family member anxious about a loved one in the hospital, maybe it’s a sigh of relief. As a patient, maybe it’s an overwhelming fear of incoming bad news. Health care chaplaincy is chronically misunderstood, beginning with …
It’s time to stop being skeptical of hospital chaplains
Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”
Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.
Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …
Debunking the myth that life gets easier once you finish medical training
The World War II veteran, now in his 90s and receiving hospice for end-of-life care, was playing military anthems on his harmonica for fellow veterans. But the next minute, reliving the horrors of combat, he grew agitated and started to cry. “Oh, all those bodies!” he suddenly called out. “Terrible, terrible! Oh, the bodies.” He finally blurted out what he had kept to himself for decades. Two days later, he …
How we can help our veterans die in peace
An excerpt from Technology and the Doctor-Patient Relationship.
As disturbing as the structure of malpractice insurance is in America, a more significant problem is the defensive style of medical practice it induces. In a large-scale survey done by Jackson Healthcare in 2010, between 73-92% of physicians self-reported ordering unnecessary …
A solution to reduce defensive medicine
Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.”
All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients …
What does a cardiologist think of the keto diet?
An excerpt from Career & Life Planning Guidebook for Medical Residents: The Best Part of Your Journey Is about to Begin.
Life is a journey. Where is this journey of life taking you? Do you know? If I asked you where you will be in seven years, could you tell …
Physicians must first establish their life priorities
It’s Monday, I recall as I step into work;
“Preparing for battle,” I say with a smirk.
Surviving all weekend with a sick kid in tow,
the parents’ relief as they waited to show
you their child with fever, diarrhea and sneezing,
the one who is too hot, too cold or is freezing,
the one who forgot that a helmet is needed,
the one who is eating too much, they conceded.
The one who still haunts you when …
A poem for the pediatrician on a Monday
We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases.
Look at the image above. The classic, Muller-Lyer illusion.
We know that the two lines are the same size. But no matter how much we intuitively “know” this to be true, we see the top line as bigger. We can’t unsee it — even if we …
How illusions impact how we practice medicine
Burnout in medicine has reached epidemic proportions. A recent systematic analysis found that the prevalence of burnout was as high as 80.5%. All medical specialties are affected, although prevalence rates of burnout vary widely between specialties.
Classically, burnout is defined as a triad of emotional exhaustion, depersonalization, and inefficacy. Recently, moral distress or moral injury has also been recognized as a potential component of Read more…
How compensation can affect physician burnout
I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.
It is an easy task to miss the diagnosis. Every physician has done this.
The diagnosis can be …
Why diverticulitis can be an elusive diagnosis
Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments …
What rushed patient encounters are doing to patients and physicians
A guest column by the American College of Physicians, exclusive to KevinMD.com.
The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.
No medical specialty is immune from the upward …
How the administrative burden contributes to physician burnout
Next in a series.
In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …
How to structure financial incentives in our health care system
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black.
On physical examination, vital signs and other examination findings are normal.
A peripheral blood smear shows …
MKSAP: 28-year-old woman follows-up after a pre-employment physical examination
I woke up to him, pacing the bedroom.
Within an hour, I was pacing the ER at his bedside.
Our experience at one of the country’s best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband’s), you are forever changed. We are grateful for his continued recovery from myopericarditis. …
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