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.
A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.
The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.
For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …
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Don’t make me choose between motherhood and my career
It’s often said that pediatricians and veterinarians have the hardest jobs in medicine because their patients can’t tell them where it hurts. But the same is often true for the health care professionals treating older patients who can’t communicate well or don’t fully understand what’s being explained to them.
So, whose job is it to advocate for these patients? The answer is that everyone on the medical team must play a …
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Who should advocate for older patients in the hospital?
The only times I stood in Emily’s room without fear were the day I met her, and the day she died. These days were two long years apart, years of unhealthy snacking and spending most weekends away from my husband and son. When Emily’s name first appeared next to mine as an overnight admission, the resident physician providing the hand-off gave me a clear warning: “Good luck. She is the …
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Anonymous acts of kindness: How this physician connects with every patient
Colorado’s ski resort areas in Summit County have a high cost of living, among the highest in the country. The people who visit these places — Keystone, Breckenridge and Copper Mountain — can afford it.
Many of those who live and work there can’t, especially when they get sick.
In addition to expensive rent, they pay some of the steepest health insurance premiums in the nation. Hospital costs are …
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Is direct contracting an answer to soaring health costs?
While my forty-year parts warranty expired some time ago, leaving me with a snapped fibular styloid process not long after, the ensuing twenty-five years have not resulted in any serious medical encounters until last week. Following a very pleasant early evening session with our Congresswoman and a sweet snack at home, abrupt abdominal pain progressed in under two hours to a clinical acute abdomen. As I got dizzy and dependent …
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The medical record often doesn’t capture the care of the clinician team
When looking at the way medical education and patient care is delivered, there is no question that there is a culture of “knowing.” From the moment a pre-med enters high school, they are bombarded with tests that assess knowledge. This extends throughout medical training, where the development of an assessment and plan in residency is paramount in the transition to an attending physician who must make autonomous decisions for their …
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Communicating honestly with patients about uncertainty
The millennial generation is known for its desire and ability to change the status quo. As this group continues to enter and dominate the workforce, particularly as our current residents and medical students, employers are adjusting their long-held practices to reinvent their culture and ensure long-term access to young, top talent.
Can you give this generation the same dress code as you did the baby boomers and expect the same result? …
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Why millennials in medicine want a different dress code
People often compare internship to drinking from a fire hose. Overwhelmed by new information and workflow, interns (especially international) usually do not have a clear direction about how to optimize their working/learning experience. Here are some tips for interns to smooth their transition from a newbie into a high-functioning intern in the setting of medicine inpatient wards.
Success leaves clues
Don’t explore yourself, specifically ask your upper-level resident about the most productive …
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4 actionable tips for new medical interns
Recently, my niece gingerly confided that she was going to study engineering rather than medicine. I was certain she’d become a doctor – so deep was her love for biology and her deference to our family tradition. But she calculated, as would anyone with common sense, that with an engineering degree and an MBA, she’d be working for a multinational company making a comfortable income by twenty-eight. If she stuck …
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Becoming a doctor in India can be life-threatening
My classmate and I looked at each other with amusement and embarrassment as we learned that all medical students would now be required to launder their white coats at the hospital. After several complaints that medical student’s white coats did not appear as “white” as they should, the university decided to take matters into their own hands. I looked down at my own white coat, which was due for a …
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The white coat serves as a daily reminder of the Hippocratic oath
As a law student, I recently was a legal extern at a hospital this summer. It’s a crazy thought because when I started medical school back in Fall 2015, my bus would pass through the pick-up/drop off zone at the hospital every single day at 7:43 a.m. I always saw physicians with their long white coats and coffees in hand walking through the automatic sliding doors. I too saw patients …
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What this medical student learned as a legal extern
Did you know that the traditional doctor’s white coat that you probably associate with your physician actually was a look that doctors “borrowed” from another profession? Back in the early days of doctoring, to add some perceived legitimacy to the title physician, the white coat look was adopted from our colleagues in the hard sciences who did actual experiments in the lab. If you recall, what we doctors call a “white …
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White coats should no longer be worn by physicians
I shared my assessment and plan with the preceptor as she walked into the room. She cut me off, “You think this patient needs surgery?” she smirked. “He has no idea what he is talking about, don’t mind him,” she whispered loudly to the patient. I kept quiet until the patient left, and my preceptor began writing her note. I pulled up a recent research article I had found prior …
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Who are the best educators for medical students?
When we think about clinical reasoning, most talks focus on diagnostic errors and the reasons for those errors. The legacy of Kahneman and Tversky focuses on errors and the many named mistakes we make. We focus on avoiding errors, but their work and too often our teaching does not focus on the road to diagnostic excellence.
Gary Klein, the pioneer of naturalistic decision making, has focused more on the road to …
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Think of diagnostic excellence as playing smooth jazz
“Planned death.”
When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.
When necessary, we prognosticate. But …
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A critical discussion is needed about planned death
“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but …
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What The Big Sick says about our profession
“What’s the most common missed fracture?” my supervising PA asked during my clinical rotation in the emergency department. “The second one,” I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions.
Unfortunately, I didn’t always know …
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Roundsmanship: the skill you didn’t know you needed
Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results.
The survival strategies of the interns in …
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When should physicians read the House of God?
