Kristin Puhl, MD

Kristin Puhl is a family physician and can be reached on Twitter @kristinpuhl.

Don’t be like Elon Musk. Get a lawyer for your clinic.

Physician

December 13, 2022

Employers need lawyers. This doesn’t just apply in medicine — it’s true everywhere. For a recent high-profile example, let’s consider Twitter. If massive layoffs had been made without adequate notice as required by California law, they could be on the hook for millions of dollars in damages.

However, medicine likes to consider itself as different from other businesses. It’s a nice idea, this fantasy of the country doctor who delivers babies …

We get what we incentivize

Kristin Puhl, MD

Physician

December 1, 2022

We get what we incentivize.

This is a basic rule. I’d love to say it’s a basic rule of humanity, but unfortunately, I have a background in psychology, so I know it goes a lot deeper than that—it’s a basic rule of every living creature. Humans are, in many ways, just very big pigeons. We reliably prioritize certain rewards. We prefer smaller sooner rewards to larger later rewards; we push the …

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We get what we incentivize

What do doctors do when they get sick?

Kristin Puhl, MD

Physician

June 1, 2022

Doctors don’t get sick. Right?

We’re certainly not supposed to. Throughout our training, the consequences of illness are dire—if you have to miss a day, someone else, someone you know well and care about, will have to fill in. They will probably have to fill in on their one day off that week. You know they’ll be angry and sad. If you’re still a med student rather than a resident, the …

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What do doctors do when they get sick?

Training rural physicians is racial justice

Kristin Puhl, MD

Physician

April 25, 2021

Training physicians to serve in rural areas is a vital piece of modern medical education. It’s also frequently overlooked. Most medical education institutions are in cities, because cities allow us to concentrate the learning opportunities: the specialists, the large hospitals, the high patient volumes. This creates an automatic, unintended bias among doctors—the idea that to be a good doctor, they need to practice in a city. After all, don’t you …

What do white LGBTQIA+ people owe to the black community?

Kristin Puhl, MD

Policy

June 11, 2020

“What do we owe to each other?”

If you watch television, you may recognize that as a quote from the show The Good Place; if you’re a philosophy buff, you may recognize the work of T. M. Scanlon on contractualism. Either way, it’s a good question. It comes up frequently, in one form or another, when we think about what it means to have a truly just society.

June is Pride month. …

What Pride means to this physician as an out doctor

Kristin Puhl, MD

Physician

June 15, 2019

I’ve been a doctor for a year. I’ve been out as bisexual for much longer. (I used to joke that my sexual orientation was old enough to order at a bar, but now it’s on the slog towards being able to rent its own car.)

With June comes Pride, and with Pride come so many feelings, I have difficulty organizing them all. My fierce love for my community, pain at how …

Talk with family members about their wishes long before you think you’ll need to

Kristin Puhl, MD

Physician

June 9, 2019

I’ve been a doctor for a bit under a year now. I am a family medicine intern, working in blocks at a city hospital, wearing a lot of different hats. Sometimes I’m on the labor and delivery floor, helping new lives begin; sometimes I’m on the family medicine service, caring for ill patients who may be dying. Some of the moments that have stuck with me the most this year …

How do you see psychosis?

Kristin Puhl, MD

Conditions

September 12, 2018

If you’re not a mental health professional, your exposure to psychosis may come through a variety of channels. You may know someone with a psychotic disorder; you may have a psychotic disorder yourself. You may have taken an introductory class on psychology in high school or college, and you may be aware of psychotic episodes as events in which people lose touch with some element of reality — they may …

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How do you see psychosis?

Treating mental illness: Quality of life matters

Kristin Puhl, MD

Conditions

July 1, 2018

Quality of life matters.

This straightforward assertion gets complicated when we discuss the treatment of depression. Depression is common, part of a family doctor’s daily schedule; it can affect anyone, although certain groups are at higher risk. There have been many hypotheses as to why we as a species are susceptible to depression (and its frequent companion, anxiety), but in the day to day practice of medicine, those proposed etiologies end …

Money matters to how you experience medical training. It matters a lot.

Kristin Puhl, MD

Education

May 31, 2018

Medical practice is a calling. It’s not a job, it’s not a career — it’s a vocation. And if you really love your vocation, you’ll let nothing stand in your way. Certainly not something as trivial and crass as money. After all, once you’re in practice, you’ll be raking it in, right? So why worry about that now, when you’re just beginning your medical education?

That attitude is pervasive, and it’s …

Physicians don’t know everything, and that’s OK

Kristin Puhl, MD

Education

February 27, 2018

Physicians face a host of challenges in practice, but the one that looms largest is often this — they don’t know everything.

It would be tempting to think that they do. As patients, we want them to. We want our doctors to tell us that they know what’s wrong and how to fix it. Medical mysteries are fun on television, but in our real lives, they’re profoundly unsettling and can have …

The opioid crisis makes the therapeutic relationship adversarial

Kristin Puhl, MD

Conditions

February 18, 2018

A patient with chronic pain and a physician walk into an exam room. This could be the set-up for a punchline, but in our current medical climate, it’s more often the first step in an elaborate dance that leaves both parties feeling frustrated, belittled, and ignored. Often, this is a first-time appointment rather than an established therapeutic relationship.

From the patient’s perspective, here’s what happens:

They’ve been putting off this visit for …

Lessons from the psychiatric ward

Kristin Puhl, MD

Education

January 7, 2018

The specter of the psych ward looms large in popular culture: video games, horror movies, novels — the concept of a locked inpatient psychiatric ward is shorthand for a variety of terrors. This perception is driven by a complex cocktail of factors. Psych ward patients have struggled with historical and current abuses, which are compounded by misunderstanding and ignorance around mental illness.

During third year, I spent a six-week rotation in …

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Lessons from the psychiatric ward

It’s important to give patients an idea of what to expect

Kristin Puhl, MD

Education

December 11, 2017

The familiarity that health care professionals develop with complex medical procedures and topics is the result of years upon years of hard work, and over time we become accustomed to the jargon. We use phrases like “lap chole” and “appy” without much thought when talking to each other and (if we have a momentary lapse) with patients. We take the fantastic array of medical specialties, procedures, and knowledge in our …

Teaching residents to teach will improve medical education

Kristin Puhl, MD

Education

December 1, 2017

Medical residents take on a variety of responsibilities. Some are clear, upfront, and obvious: the responsibilities they have been training for since entering medical school. Coming up with a treatment plan and carrying it out is first and foremost their raison d’etre, and they put an enormous amount of effort into it. However, they also acquire a host of other duties. They run interference for attendings. They coordinate with nursing. …

Why do doctors who hate being doctors still practice?

Kristin Puhl, MD

Education

November 20, 2017

How important is it for a doctor to want to be a doctor?

At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that …

She sees difficult patients, but is a difficult patient herself

Kristin Puhl, MD

Education

November 8, 2017

The patient is a 27-year-old Caucasian woman: slender, well-groomed. She is sitting in the office of her urologist, and she is unconsciously twisting her hands as she interrupts the doctor, having finally worked up the nerve.

“I know you told me to expect some pain for a while after the lithotripsy. But I’ve been having pain in my bladder, even when I don’t think there are any stones. It started two …

Establishing trust with LGBTQIA+ patients

Kristin Puhl, MD

Education

October 25, 2017

For patients who are part of the LGBTQIA+ community, a medical visit can be unexpectedly stressful. LGBTQIA+ people have to keep track of who they’re out to and how out they are, especially if they fit more than one letter of the acronym; some people might know they’re gay, fewer people might know they’re transgender, while some people probably don’t know anything about their private life at all.

Why does this …

Kristin Puhl, MD

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