Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.
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 …
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Doctor by day, law student by night
As physicians, we are constantly faced with a daily barrage of meeting minimum RVUs, while keeping up with EMRs as part of the necessary components to successfully practice medicine. This has resulted in a decrease in personal interactions with patients, which has caused an increase in physician burnout and suicides. Attempts to reverse these negative impacts have resulted in instituting wellness and meditation clinics and debriefing after traumatic clinical events …
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Fight burnout with a higher power
A 69-year-old man with a medical history of hypertension, diabetes, and obesity with a body mass index of 33 was admitted with altered mental status. He and his wife were returning from a 14-day Alaskan cruise. On their return, the wife started noticing that her husband was behaving strangely and acting forgetful and had short-term memory loss. This gradually progressed to generalized confusion and altered mental status leading him to …
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A possibly fishy complication of an Alaskan cruise
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 …
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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 …
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Debunking the myth that life gets easier once you finish medical training
I have just finished another round of that dreaded process that we call “the interview process.” Without fail, this process has haunted me almost cyclically every 3 to 4 years in the last 11 years of my life. First, there were medical school interviews, residency program interviews, and then lastly, fellowship interviews.
You would think that after so many rounds of applying, it would get easier. You would think after I …
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4 essential tips for residency interviews
In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse …
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The healing patient-physician analog relationship is in critical condition
The doctor shortage across the United States is coming and has the potential to be painful to millions of Americans. According to the Association of American Medical Colleges, by 2023, the country may experience a deficit of up to nearly 122,000 physicians. With more and more Americans getting access to health care because of policies like the Affordable Care Act and Medicaid expansion, and with the aging population, medical schools …
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Nurturing professional identity and maintaining pass rates: an important goal in medical education
The day began in Mom’s room with a 10:00 a.m. conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my 93-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself.
Mom was on high-flow oxygen therapy delivered through a nasal cannula. Despite this, her blood-oxygen levels were well below normal. Clearly, her lung function was declining. …
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Over 2,000 prayers for the dead. This was my hardest.
Though I owe a debt of gratitude to all of my internal medicine attendings, none of them can claim credit for getting me through the gulag of residency. That distinction, instead, belongs to Zubin Damania, alias ZdoggMD, an internist and purveyor of viral YouTube music videos.
I first became aware of Damania’s videos when a med school friend sent me a link to his online archives, resulting in one …
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How ZDoggMD inspires this physician
With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it.
Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and …
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Psychological safety in health care: simple, important, fragile
If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.
Is this proper …
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Patients: Be proactive in your health care
I am a cardiac anesthesiologist. I meet most patients I care for minutes before I take them to the operating room and render them unconscious. I breathe for them, administer pain medicine and drugs to give them amnesia, and I keep their hearts, lungs, kidneys, and brains working.
Pretty important stuff.
I want to speak on behalf of physicians.
I want all patients to know something: We need you to talk to us.
We …
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A physician’s plea to patients
Nurses are the very heart of health care. These wonderful professionals work tirelessly for the good of their patients, spending the most time with them and often being their biggest advocates and best friends during what is a frightening experience in the hospital. In my career, I’ve worked with some truly magnificent nurses, who would be an asset to any organization. Every practicing doctor has also been in situations where it’s …
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The bedside nurse is under siege
Women who become doctors must often choose between motherhood and medicine. I’m a mother and a surgeon. I never thought of choosing between the two, even though my employers often asked me to.
Today I work as a trauma surgeon in a busy practice. It’s been a long journey since the day five years ago when I …
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The stigma of motherhood in medicine
“Can we please try to be objective about this!” I said these words to myself over and over during this year’s interview season as we formulated our residency rank list. At my institution, the residents and faculty have equal sway in forming the rank list. The chief resident facilitates the resident half of the process. As the hours wore on during our last meeting, the discussion gradually deviated from assessing the …
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Objective measures aren’t perfect at predicting real-life clinical ability
Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.
The medical universe …
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Patients are used to seeing physicians who are not their doctors
The doctor opened the door after a gentle knock. He was greeted with warmth, offered a seat by Mary, and promptly sat down on the end of the hospital bed. As he sat, the family stood to greet him. They discussed the grandkids, the trips taken since they last saw each other. The room felt peaceful. Time slowed down.
Walking in behind my attending, I had been ruminating about the lengthy patient list, the work to be done. Then …
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When we walk into a patient’s room, we are entering a story
Last June, I became a freshly-minted young doctor, bright-eyed, and enthusiastic about heading off to my dream residency program. By August, I found myself crossing the street on my way home, wondering if I had made a horrible mistake that could have harmed a patient. The most painful thing was, I hardly had the energy to care.
This is not why I chose to dedicate myself to medicine.
Like many medical trainees, …
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The Resident and Fellow Bill of Rights
Residency application season has begun!
When I was applying last year, I spent a lot of time thinking not just about what programs I wanted to go to, where I wanted to live and how best to answer “Where do you see yourself in five years?” — but also trying to develop a method for making this decision. This is the mental model I came up with that helped me through …
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Applying for residency? Read this first.
