A guest column by the American College of Physicians, exclusive to KevinMD.com.
If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around.
When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify …
The ever expanding list of reasons for a doctor’s note
Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there?
I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to …
Surgical residency hurt the people that mean the most to me
CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …
How to perform services that increase primary care revenue
Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …
Why paying hospitals for clerkships is good, and necessary
I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …
Every physician is a wounded healer
“How are you feeling?”
It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …
Ask patients how they feel, along with how they are feeling
“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)
In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …
Learn the physical exam by following an oncologist
There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.
I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …
Medicine is the most emotional profession. This story proves it.
A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …
You should want surgery residents for your operation. Here’s why.
I took a fantastic emergency medicine (EM) job when I finished residency. There was no question in my mind that it was the best job within a hundred mile radius, maybe more. When I first started, my expectations were met. My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed. The hospital was independent, …
How to destroy a great ER: A step by step guide
If you are a doctor, everywhere you hear or read about all that is wrong in medicine. Please do not get me wrong, the medical profession is under assault. Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients. For many of us in the profession, we feel helpless. We feel …
Doctors need to fall back in love with medicine. Here’s how to do it.
I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy.
Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill …
Your anger towards doctors is misplaced
Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
Doctors can’t see the forest from the trees. And it’s cost them.
I just finished reading a very delightful A Piece of My Mind essay in JAMA. JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …
Who are the patients that stay in the hospital for a very long time?
As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.
As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …
How duty hour restrictions are hurting residency training
Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels. Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way.
In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead …
Making your own infant formula at home is a recipe for disaster
No, customer service in the U.S. is terrible when it comes to health care. No, the customer service in the U.S. health care system is horrendous. No, health care has the worst customer service of any industry in the U.S.
There. That seems about right.
What makes me utter such a bold statement? Experience. I regularly hear the following from people when they come to my practice:
American health care has a customer service problem
Back in my first year of blogging, I wrote a post, titled “A Day Without a Diagnosis,” about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school.
That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring.
My first patient of the day was …
A refreshing day of real doctoring
An excerpt from What It’s Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician, Greenbranch Publishing, 2016.
I passed the board exam in November 2011 to become a gastroenterologist. This is the last exam I have to take until I recertify in internal medicine in 7 …
This is what life is like for a gastroenterologist
“I hereby authorize xxx, my patient, to donate plasma up to two times per week.”
I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma.
By the time the fourth form came, I realized …
Permission to take my patients’ plasma. It’s a harder decision than you think.
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