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 teach first-year medical students how to take a medical history and perform physical exams on patients.
These skills are the foundation of medicine. The history and physical exam (plus a few basic tests) are time-tested methods for diagnosing disease. Using these tools, a skilled physician can reach an accurate diagnosis more often than not.
We humans share a standard range of symptoms. Pain, weight loss, fever, cough, abdominal complaints: They are …
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Why this physician teaches first-year medical students
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 …
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Money matters to how you experience medical training. It matters a lot.
There have certainly been numerous articles, periodicals, missives, messages, courses and LinkedIn articles about the importance of strong leadership. I myself have blogged that most “challenges” in hospital medicine could likely be solved with strong leadership and adequate staffing.
But recently I gave a talk with Sarah Apgar from UCSF on differences in supervision and collaboration. During that talk, we investigated what it means to be a functional “member” of a …
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The 4 types of low-functioning health care team members
The path to becoming a physician is a long and character-defining one. From the moment one first realizes that they want to become a doctor, applies to medical school, and then goes through the rigorous next few years of exam after exam and exhausting clinical rotations — the road is certainly not for the faint-hearted. Everybody is aware of how much knowledge and hard work is required to become a …
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These 2 events made this doctor a more compassionate physician
If a person is outside of the medical field it can sometimes be difficult for them to perceive what it is like to be a physician. One of the most surprising places to get an inside view of both the personal and professional lives of the people behind the white coat is on TV. Although there are many inaccuracies in TV shows with a medical framework, one thing that a …
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Medical TV shows give insight into the lives of physicians
Strong letters of recommendation are essential for supporting your residency application and matching well. This article details how to ensure you get great letters of recommendation.
Knowing what constitutes a great letter of recommendation is crucial to obtaining outstanding letters. A strong letter of recommendation clearly conveys knowledge of the medical student, how that student performed and qualities that predict excellent performance in residency. Strong letters of recommendation include the following:
How to ask for a great letter of recommendation for residency
I log onto KevinMD every day to get my much-needed dose of physician commiseration. At least once a day, one of us writes an article about burnout. It typically leaves me feeling quite validated. I particularly enjoy reading the comments section, as many of you make me laugh with your physician reality-based humor.
I am more burned out than I ever hoped to be. I work in primary care, have a …
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This burned out physician was happier as a resident
“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!”
I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the …
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How to deal with devastating criticism
Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won’t take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn’t need to wait the last hour.
She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, …
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Cushioning the fall of bad news
The tragic case of Alfie Evans has roiled Great Britain and the world. Alfie was a two-year-old child in the United Kingdom with an unknown degenerative brain disease who eventually deteriorated to the point that he required life support. His brain had become mostly liquid, and he could not see, speak, or hear. Alder Hey Hospital decided his condition was terminal and irreversible and wanted to stop …
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The dangerous precedent of Alfie Evans
“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom. I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming.
“Why the f*** would they think I need to be consulted for this? Only …
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Don’t be mean: Treat your team members with respect
One of the things that can help a physician live a balanced life is finding ways to thrive in the workplace. This is currently a work in progress for me, but I am excited to share what I have learned so far. For some context, I was previously practicing as a nephrologist; and I transitioned to being a hospitalist on an as-needed basis to create flexibility in my schedule. This …
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Physician, heal thyself: How to thrive in your medical career
We are in the midst of an epidemic of physician burnout, depression and suicide. Although the causes are debatable, there can be little doubt that increasing demands for financial performance and patient satisfaction, decreasing autonomy, and physicians’ individual liability for systemic risk management decisions in a majority of practice settings are significant contributors to these adverse outcomes.
At the same time physician burnout, depression, and suicide rates have been rising; tremendous …
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It’s time for hospitals to publicly disclose physician satisfaction, burnout, and suicide rates
I recently needed to transfer my patient to a larger medical center for some urgent care. As I sat there in my relatively small hospital working out where they would be best served, a famous academic medical center that was not too far away, came to mind. I placed a call to the facility’s bed facilitator, who took the patient’s details from me, and was told to await a callback …
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Why the battle against being called a provider is probably lost
The recent passing of former first lady Barbara Bush, an American icon, also brought a commonly debated discussion to light, palliative, and end of life care. Many articles were published regarding her last days, mentioning she was “foregoing further medical care” or “no longer pursuing medical treatment.” These types of statements are not only inaccurate, they also minimize the incredible medical care provided by palliative care and hospice teams.
To realize …
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How Barbara Bush’s legacy can help us rediscover the benefits of palliative care and hospice
I recently received a call from a physician resident in the Northeast U.S. who had been notified that she would be terminated from her residency program for a “weak knowledge base.” There would be no contract offered to her for the coming academic year. She reports that her scores are no worse than several of her colleagues and that her accredited program has a history of arbitrarily dismissing residents. She …
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Medical residents and academic due process: Know your rights
The ability to lead is not something that comes naturally to everyone. There are some people out there who are wired to lead right from when they are very young — but these are few and far between. Most of us have to train ourselves, and acquire the necessary leadership skills based on our own learning curve and experiences. The fact is that we are all leaders in one way …
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Physicians are CEOs of their medical floors
Undoubtedly, my favorite part of my non-clinical work is hearing from fellow physicians about their lives in medicine. Every once in a while, I receive an email that puts beautifully into words some of my own struggles.
A few weeks ago, I received an email from a colleague outlining her personal journey through her career, which she was hoping other physicians would benefit from as well. I know it spoke to …
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How do we keep women physicians in medicine?
“Hey, man, I’ve been getting destroyed all night running four ORs and haven’t eaten. I am going to eat dinner before I get out of here. If anything emergent comes up, I can help out. Just let me know.”
As I wash my hands right after I hang up the phone, the overhead call comes out: “Attention. Your attention, please. A Level 1 trauma code has been activated in the adult …
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A doctor’s life. Ready. Rinse. Repeat.
