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.
For the last 8 years, I have worked as a locum tenens hospitalist. I began on this path when it was the least popular option upon graduation from residency.
I did countless hours of research trying to find accurate information about locum tenens companies, but never found anything written by physicians, only by the companies themselves. So, I stepped into this field blindfolded and learned the hard way. Since then, I have …
Read more…
5 mistakes hospitalists should avoid when starting a locum tenens position
During the 1990s Dr. Jack Kevorkian drove his Volkswagen van through an unmet need in American medicine euthanizing 130 patients who felt death was the only solution to their suffering. He euthanized his “patients” with devices he named the “Thanatron” and the “Mercitron.” The former allowed his patients to administer IV barbiturates and potassium while to latter delivered carbon monoxide. When convicted of manslaughter, he told the court, “Dying is …
Read more…
The physician-assisted suicide predicament
My first patient of the day has metastatic pancreatic cancer. She’s had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she’s been in and out of the hospital.
Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. “Tell her to focus on the positive,” they request. I wonder if there …
Read more…
An emotional day as a doctor
“The worst enemy of a doctor is another doctor,” said one of my professors during rounds when I was doing my internal medicine clerkship as a third-year medical student.
I remained skeptical. That did not match the idea of becoming a doctor nor did it support what Dr. Pellegrini said: “Medicine is the most humane of the sciences.”
Nonetheless, my old professor explained that when it comes to patient care planning and …
Read more…
The worst enemy of a doctor should never be another doctor
I will graduate from medical school next week. As it winds down, I’ve spent a lot of time reflecting on what I’ve learned and how I’ve changed over the past five years.
Obviously, I now know a lot more about medicine. There’s no escaping the need to absorb an enormous volume of information. I can rattle off the symptoms, mechanisms, and treatments for heart failure, diabetes, syphilis, and dozens of other …
Read more…
A graduating medical student reflects on the last few years
Congratulations! You made it through medical school, got your MD/DO degree, and can officially be called doctor! One day, you’re a student. The next, you’re a doctor and with that come the responsibility, trust, compassion, and professionalism associated with our career. But how do you transition?
It starts with your mindset and then deciding to be the best doctor you can be. Your thoughts inspire your words, which direct your actions.
I …
Read more…
The new doc on the block: 7 lessons from my first year of being a doctor
1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …
Read more…
7 habits of being on call
It seems like every other day, there’s a new discussion or debate which emerges about the unique challenges that minorities face in America. This is, of course, a sensitive topic, because minorities in any arena will always have their personal story. Whether it’s because of your color, or anything else that makes you feel like you face extra hurdles — there are indeed lots of ways in which society still …
Read more…
How this physician deals with race-based comments
Very many years ago, as a medical student, I remember caring for a twenty-something-year-old in the intensive care unit (ICU) with a very severe infection that resulted in her being in the ventilator for months. Let’s call her Jane. Her hospital course was complicated: re-infections, loss of digits, muscle wasting.
The ICU was closed to families during morning rounds which is when all the doctors in their white coats gathered and …
Read more…
Don’t go to the hospital alone
The vast majority of births and deliveries are joyful ones. Families celebrate the wonder of the new addition to their families, and clinicians go home at the end of the day with a sense of pride, deriving meaning from their professional lives. This is one of the reasons that many of us chose obstetrics in the first place.
But unfortunately, that is not always the case.
As an obstetrician, I know firsthand …
Read more…
When outcomes are tragic, doctors suffer too
Physicians do not have a lot of power these days. But if you know when, where and how to look, we can, on occasion, score some victories.
Case in point: hospital bylaws that every physician is required to acknowledge and sign before being granted privileges. It is always a good idea to carefully read before signing anything, and I did the just that before signing my hospital’s bylaws. I asked a …
Read more…
Hospital bylaws saved this doctor from EMR burnout
Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing.
It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide.
There’s another side to this story, though. Like all of life’s great challenges, a patient’s unexpected loss, and professional litigation present us with huge opportunities for growth.
I am …
Read more…
5 ways to live through medical malpractice lawsuits
I visit him in the ICU day in and day out. It’s the man with the fedora. I see him every day because he is not going anywhere. The metastatic cancer has ravaged his colon, bones, liver, and lungs. His oncologist is willing to try more chemo — but not now — maybe someday “when he is stronger.” The man has already failed several other regimens. The oncologist hasn’t seen …
Read more…
The man with the fedora in the ICU
When I was an intern on the cardiology service, I rarely left before 10 p.m. Call days were longer. One day in the workroom, I noticed my co-intern sniffling as she typed progress notes. Her eyes were red. “Are you OK?” I asked.
She said, “I just cried in the bathroom for about ten minutes. It’s nothing bad; it’s just … I’m so tired. Do you ever feel so tired you …
Read more…
Mindfulness is not the answer for burnout
As a medical student, every eight weeks I rotate through a new specialty in a new hospital or health service. This means every eight weeks, I flick over to a new chapter in my textbook, learn a new set of medical lingo, meet a new team of doctors and a new cohort of patients. As a person of color, however, this translates to something far more challenging yet predictable. It …
Read more…
Fight systemic racism in medicine
Leaving the nursing profession is bittersweet. My heart left nursing a while ago when I came to the realization that nursing left me first. It never was a two-way relationship. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress (PTS).
First responders and emergency workers often hear the phrase, “It’s just part of the job.” So we all just deal with it — or not. I’ve heard this …
Read more…
Here’s why I left nursing
On my morning commute as I read this NPR article, memories started flooding my brain. I could not control myself and had to write this.
My last name “Theetha Kariyanna” has its origin from a small village Theetha and added to it is my dad’s name Kariyanna (a local folk god). Back in my school days, the name was weird to my friends as the name …
Read more…
The caste system is thriving in medicine in the U.S.
Mr. F points a slender index finger to the heavens and states calmly: “It’s OK doctor. Jesus will protect me.” I had just said I was sorry there was nothing more we could offer, and he was going to die. He understood … right? It had been a difficult few months for my unfortunate patient. He smiles at me softly, nasogastric tube cascading over his right cheek and then closes …
Read more…
An average day of tragedy in the hospital
Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year.
For the uninitiated, “work” as a medical …
Read more…
It’s time to recognize the rights of medical students and residents
It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.
Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so …
Read more…
Life on the night shift at the hospital
