“Does a rock float on water?” I asked the haggard woman lying in the ICU bed.
I was an intern, in the first rotation of my medical residency, and Mrs. Jones had been my ICU team’s patient for the past week. Over that time, she’d looked more and more uncomfortable, constantly gesturing for her breathing tube to be removed.
Mrs. Jones tried to form words in response to my question, but the …
What do you do when all else fails with a patient?
I am just another average physician.
It wasn’t my first return from maternity leave, but this busy ED shift wasn’t going well. I kept putting off breast-pumping to complete “just one more thing.” Then my son’s school secretary called. I had told our nanny the wrong pick-up time. She wasn’t answering her phone. I was disappointed in myself and frustrated that I couldn’t leave. But I am a physician — I …
Average physicians are extraordinary
Yes, med-peds is a real residency! It is a real specialty! And it is a practicing profession by many physicians today! It can open doors for so many wonderful professional opportunities. It is a discipline that can provide patients and communities extremely comprehensive medical care. People need to know more about this unique and sometimes under-recognized field. And here is why:
Like many people today, I didn’t even know what med-peds …
The myths and truths about med-peds physicians
It is a known fact, but every generation feels that they had it worst and that other generations have it made.
“When I went to school we had to walk uphill in the snow both ways!” says every grandparent
I identify myself with the Generation X physicians, finishing medical school in 1997 and my radiology residency and fellowship training in 2003.
During this time I have seen quite a change in the medical …
The generational differences of physicians
I have had several dealings with the benefits managers/HR managers of large corporations and other large organizations over my career. I have one over-arching conclusion about what motivates these people: They will never be a source of disruptive innovation in health care.
I find them to be passive people. They are fundamentally people pleasers. They derive joy from helping their employees navigate their insurance plans, figure out deductibles and co-pays, explain …
Why managers will never be a source of disruptive innovation in health care
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
I imagine every physician anesthesiologist has experienced drug or equipment shortages in the last year. How frustrating that even in the world’s largest health care system, basic medications can be unavailable. However, when I step back and look at the big picture, I …
Reflecting on the state of global anesthesia
I was having dinner with somebody not so long ago, and the conversation turned to what life is like as a physician. I always find it interesting to have these conversations with people who are not in the medical field, especially those who have got their ideas from watching medical shows on television! The person I was speaking to on this occasion, however, wasn’t about to go down that route, …
Health care professionals must always be on their A game
Veterans do not only matter one day of the year. Beyond Veterans Day, it is not only important to reflect on the lives lost and the sacrifices made by those who served our country, but to ask: are we doing enough as a nation to give veterans the support and care that they need? Veterans deserve to be more than a political football. We discuss “supporting our troops” and “honoring …
Leaving no veteran behind when it comes to health care access
With over 22 million page views for the year, thank you for making 2018 such a success.
KevinMD continues to be the web’s leading platform that highlights the voice of the many who intersect with our health care system, but are rarely heard elsewhere: physicians, advanced practitioners, nurses, medical students, and patients who can share their insight and tell their stories.
This year, I’m …
KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians
Physicians receive rigorous medical training for the better part of a decade. However, we emerge unprepared for the real-world job application process to which our friends in other professions are accustomed. One of these logistics includes credentialing and verification for hospitals and clinics where your group intends to practice — a process that can take up to three months.
There are a number of items that are requested during the credentialing …
12 things you’ll need for a smooth credentialing process
A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance …
The 3 goals of clinical documentation
I recently completed my internal medicine residency training. Three years, thousands of hours, thousands of patients, thousands of decisions. I certainly learned a lot from the past three years: everything from what “HFrEF” means and how to manage it, to treating recurrent C. difficile colitis, to how to share decision-making with patients about whether or not to start anticoagulation in atrial fibrillation. Despite the multitude of lessons I have learned from my co-residents, …
3 lessons this physician learned from her patients
I’ve always believed in looking the part as a physician. So much so that I even write about it! You may have read my piece that became widely circulated online, about why physicians should always dress to impress. The article generated quite a response, and I received a lot of interesting comments and emails. Of course, not all physicians are in a specialty where they can do …
Why this physician doesn’t dress down when rounding on weekends
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When I was in medical school, I didn’t realize the potential data would have in health care. Back then I learned from 1000+ page hardcover textbooks and handwrote notes in paper medical records.
Fast forward twenty years — data and analytics are at the forefront of health care. Other doctors and I now have electronic medical records in the majority of hospitals and medical offices; there are claims data warehouses, and …
How doctors can distinguish themselves in a data-driven world
We recently had a patient who arrived on our service in the intensive care unit after a complicated surgery. The surgery left him close to dying, and he was immediately put on life support and given heavy sedatives.
Ventilators breathed for him. Special drugs kept his heart beating. A continuous pump acted as his kidneys, filtering out his body’s toxins and infusing the cleaned blood back into his veins anew.
He had …
Treating the patient’s body is not synonymous with treating the patient
A wonderful senior resident helped me understand the goal of rounding. Rounds should focus primarily on understanding the key problems and the diagnostic and therapeutic approaches to those problems. She suggested that some rounds spend too much time on “minutia” that the resident could handle, and not enough on understanding the big issues. According to her, rounds work best when we spend our time addressing the problems that the patient …
The key to successful rounding
Our country is at risk of losing an iconic institution that has played a pivotal role in the history of medical education. A school, which has produced some of the boldest pioneers in medicine, could lose accreditation upon the opening of a new hospital that will shunt away 40 percent of their current patients. Scores of our brightest potential medical students will be ripped away from the communities that desperately …
The fight to save Howard University College of Medicine
“I am really uncomfortable and in pain,” said Elaine tearfully as I met her in the preoperative area for the first time. She had a very sad and difficult history, dealing with complications from childbirth nearly two years ago. She had developed a communication between her rectum and vagina, which allowed feces to come out vaginally. Despite multiple surgeries from reputable medical centers in NYC, the problem recurred. And she …
The simplest treatment is sometimes the best
I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue …
The Wild West approach to PICU practice
Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get …
The millions of dollars hospitals spend for inspections
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