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.
It’s something that’s not taught anywhere near enough as it should be in medical school, but every practicing physician quickly realizes that communication is everything in health care. It’s the foundation of the doctor-patient relationship, and what patients will judge you on. Sure, doctors are among the busiest professionals out there. We do an incredibly hectic job. But it’s so imperative to remember the importance of that interaction with your …
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10 golden communication tips for doctors. And 3 things they shouldn’t do.
In theory, of course, it’s a great idea for people to give their opinions and rate their experiences with any goods or services they buy. The notion goes back long before the Internet with publications like Consumer Reports, which is now itself online. Sites such as Angie’s List are very popular and can give you testimonials about providers of everything from home renovations to car repair to daycare. So it’s not surprising several …
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Online physician reviews: A physician does a study on himself
It was 5:30 a.m., and I was startled to feel the nudge of my husband’s hand on my arm while vaguely hearing the sound of my alarm going off in the background. Although I was not prepared mentally to get up for another day, I quickly jumped out of bed so as not to allow the sound to wake my sleeping daughter in the next room. I cherished no actually, …
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Residency and family: How this resident finds balance
My dad died on May 11, 2003. It was Mother’s Day. I was 18 years old. Those are the easy facts. The more difficult ones are those detailing the events that led to his death. My dad was so many things — a brilliant geologist, a loving father, an inventor, a pilot, and a Vietnam veteran — to name a few. He survived three tours on the front lines in …
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The smallest human acts can have a lifetime of impact
My spry, 90-year-old patient decided she had a urinary tract infection two weeks ago. She had difficulty urinating and the constant urge to void with no fever, no chills, no back pain, no bloody urine. She was advised to come in for an appointment the same morning, but this didn’t suit her. The alternative choice was to see her urologist who made time available that same day. She decided this …
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Why Medicare cannot stay solvent: a case study
It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on …
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My heart goes out to all of the first responders
Dear medical student, I’m sorry.
You had just finished two years of didactic learning and couldn’t wait to feel like a “real” doctor. You finally were starting your clerkships, that is, ultimately working with patients and getting deep in the trenches.
You were bright-eyed as you pulled on your pristine short white coat. You got to the hospital at 5:15 a.m., 15-minutes early for the first day of your very first third-year …
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An open apology to medical students from a resident
Physician burnout and physician suicide have been getting more attention in the last several years. Suicide among physicians is horribly tragic, and maybe moreso because of several factors. Suicide is the quintessentially most preventable fatal event. In order to prevent suicide, the person killing him or herself needs only not do it. To anyone who knows the victim/perpetrator, it seems that if only the right words had been spoken, the …
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A physician’s experience with burnout, and what she learned about it
Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with …
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The high cost of hospitalists
“It is not for me to judge another man’s life. I must judge, I must choose,
I must spurn, purely for myself. For myself, alone.”
-Hermann Hesse, “Siddhartha”
What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But …
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Death is certain. How you choose to die isn’t.
Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days.
“Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.”
“Good to know. We may have to change the dressing more frequently.”
“And this patient had constant …
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People, not computers, make health care work
Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine.
Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment …
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Doctors are dangerously tired, and health care leaders aren’t taking action
So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …
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Emergency medicine can be exhausting. Here’s what this doctor does to unwind.
When asked to describe my career, I consider myself primarily a clinician educator. Recently I have reflected on the influences that allowed me to have a successful career doing what I love. This post is not meant to mention all those influencers, but just some that I recall often. As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education. …
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An ode to great clinician-educators
November brings fall weather, raking leaves and one of my favorite holidays. No, not Thanksgiving, it is Veteran’s Day. Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service. Thank you, veterans. Veterans are found in all segments of our society. Some are retired, some have started second careers, and some are struggling with health issues as a result of their service. They …
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Why veterans deserve special recognition
8:00 a.m.: Monday mornings are abhorred by almost everyone, but they are gloomier if you work as an intern. For me, this Monday was an anticipated work-free day — hence, it wasn’t too bad.
I had spent a long time at breakfast catching up with friends and later grabbed my books and went to the library to catch up on my studies. This happiness was short lived. And in the afternoon, …
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Always ask your patient this one thing
College → medical school → residency → fellowship. The journey to becoming a doctor sometimes feels like climbing a never-ending ladder. The process started for me as an undergraduate when I was seventeen years old and will go on well into my thirties. I am still climbing. Each level of ascension is drastically different in both your skill set and responsibilities to your patients. The variation from one stage to …
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Being a specialist is a constant climb. But it’s worth it.
I bleed blue and gold. No, I am not talking about Michigan, West Virginia or Notre Dame. I am definitely not talking about UCLA Bruins (by the way, UCLA fans, a bruin is a brown bear). That’s right — I am a die-hard Cal Bears fan.
Thanks to Cal football, and particularly to legendary Marshawn Lynch, my college days were filled with excitement. (I am counting on you, Coach Wilcox.) Marshawn, …
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How do you fight racism in medicine?
