Primary Care

Burnout follows from physician to wellness director

Physician

May 6, 2022

Tuesday, at the podium in a small auditorium, I realized that my time was finally up. Even as an educator/administrator (non-clinical) physician, I was done. Preparing to give a canned talk — a requirement of my current career strategy — facing a group of anonymous medical students, the only thought going through my head was, “Why don’t we blow through these slides and get out of here?”

Normally, I relish public …

The inevitable reboot of the primary care experience

Paul Helmuth, MD

Physician

May 5, 2022

Visiting the doctor’s office can be a source of anxiety for millions of patients, who often fear unknown costs, an unexpected diagnosis, or exposure risk to diseases, like COVID-19.

On the other side of the equation, business stakeholders of a community-based primary care setting are struggling to exist within the confines of 20th-century technology and strategies. The Physicians Foundation estimates that 16,000 physician practices closed during the pandemic …

Doctors are trained to lie

Pamela Wible, MD

Physician

May 4, 2022

Here are the top 10 ways how and why doctors lie. See if you recognize any.

1. Doctors lie about work hours. When logging actual work hours exceeding the weekly “80-hour cap,” new docs are cited for duty-hour violations. Labeled as inefficient, overworked residents may be sent for a psych eval and prescribed stimulants to force compliance. “We were all taken into a room by the program director and told to …

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Doctors are trained to lie

Want to improve your patient reviews or relationships? Learn to be present.

Diana Londoño, MD

Physician

May 2, 2022

I recently came across an article in the Journal of Urology that was trying to understand the determinants of patient satisfaction in the outpatient setting. They surveyed 500 patients over two months and asked questions about demographics, expectations regarding the time frame to obtain an appointment, appointment wait times, and the amount of time they expected to be spent with them, as well as expectations of being …

Your doctor may already be gone

Anonymous

Physician

April 30, 2022

The doctor you are seeing may have already left medicine.

Yes, you still have an appointment.

Yes, they are still in the room, taking your history and performing a physical exam.

But inside their mind, they have already decided.

They haven’t said it out loud.

There’s been no official resignation letter.

But it’s a done deal.

It may be six months from now or ten or twenty-four.

It doesn’t matter because the decision has …

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Your doctor may already be gone

The dichotomy of patient needs and patient wants

Paul Pender, MD

Physician

April 30, 2022

As a practicing ophthalmologist, I saw many patients who had developed blurred vision, glare, or trouble reading. These patients needed to understand that cataracts were the cause of their vision problems and how the cataracts developed and how they should be treated. I would begin the explanation by using a large, plastic eye model to show the lens’s position and how a clouded lens would affect vision. I would then …

When quality measures interfere with good care

Michael McCutchen, MD, MBA

Policy

April 30, 2022

All medical professionals are familiar with the jargon: quality metrics, P4P, low-cost/high-value care, PQRS, and meaningful use. We see these terms in multiple emails, staff and clinical meetings, and organization-wide initiatives. These measures and guidelines will significantly impact the type and quality of care we provide to our patients and how we are paid for it. This movement is not necessarily detrimental and could lead to improved health among …

Why is it hard to find grace in medicine?

Marsha Hamner, MD

Physician

April 29, 2022

“If I make a mistake, my patient could go home in a body bag.”

I don’t recall whom I first heard this from, but it stuck in my mind as terrifying thoughts do. And we wonder why burnout in medicine is a thing.

Mistakes in medicine can cause mortal consequences. They can harm another human being. We can’t escape this reality. We can’t undo it. We don’t get “three lives,” as in …

How to be more like fungi

Sarah Averill, MD

Physician

April 29, 2022

“Mycelium is ecological connective tissue, the living seam by which much of the world is stitched into relation.”
-Merlin Sheldrake

Merlin Sheldrake invites us to see the world from the point of view of mycelium. He coaxes the reader to “[i]magine that [they] could pass through two doors at once. It’s inconceivable, yet fungi do it all the time. When faced with a forked path, fungal hyphae don’t have to choose one …

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How to be more like fungi

What it means to be board certified in health and wellness coaching

Jessica Singh, MD

Physician

April 28, 2022

After I passed my emergency medicine oral boards in 2019, I learned that the American Board of Emergency Medicine was implementing MyEMCert modules, an alternative means of maintaining certification. I was so excited never to have to take a multiple-hour board exam again. However, now that I have become a holistic coach, I find myself preparing for the National Board of …

10 ways medicine is like the airline industry

Marc Braunstein, MD, PhD

Physician

April 25, 2022

I am standing before a team of fellows, residents, medical students, and pharmacists on Monday morning about to start rounds on the oncology service. And as the intern is about to dive into the first patient presentation, I take a moment to ask a question: “Is anyone here into aviation?” This context is met with an awkward pause, people’s eyes looking down, and a bit of confusion. I make an …

What do we do with our sadness and anger?

Tracey O'Connell, MD

Physician

April 18, 2022

When my boys were little, they responded to frustration differently. One would get angry, throw toys, yell, bite, refuse to cooperate. The other would become pitifully sad, appearing abandoned or lonely.

The sad one received more attention because when we see someone who’s sad, it pulls on our heartstrings and evokes innate compassion. Seeing another in a low energy, low pleasantness state makes us want to reach out and offer comfort. …

How to prepare to be an effective caregiver

Miles J. Varn, MD

Physician

April 17, 2022

At some point, most of us will take on the role of caregiver. You may be caring for your parent or older family member, a spouse or partner, or a close friend. As the population ages, the number of people in the U.S. who are caregivers is growing significantly. Caregiving in the U.S. 2020, a report from The National Alliance for Caregiving, found that the number of …

Hidden wonders of human anatomy [PODCAST]

The Podcast by KevinMD

Podcast

April 15, 2022

“It turns out that living beings are less like bags of sloshing water, as I imagined in grade school, and more like a stew. While water makes up most of it, water alone is thin and empty of the organic molecules from which organisms are built—the stew thickeners. Water …

A surprising way to create safer, more efficient patient care

Nance Goldstein, PhD

Conditions

April 13, 2022

For practicing physicians, inclusivity proves critical.

Not because of HR mandates. Not because it’s a good thing to do.

Inclusivity improves your patients’ care. It enables you to be a better doctor.

Rising complexity, rapid change, and treating far-flung patients mean physicians need information from all angles of care.

Physicians need to know that everyone participating in your patients’ care can tell you vital information. They must feel safe and comfortable communicating with you …

Writing is an outlet for this physician [PODCAST]

The Podcast by KevinMD

Podcast

April 12, 2022

“There is something about physically putting pen to paper, that connection between your mind and your body that is just very health-inducing. And it takes time. And often we do not dedicate the time to taking care of ourselves and something as simple as writing in a journal, writing these, …

Seen but not heard: How does the medical system value its scribes?

Kyle A. Swearingen, MD

Physician

April 12, 2022

As an off-cycle medical student with an extended break between the completion of my M4 rotations and the conferment of my MD, I took a job as a medical scribe to keep myself active in the clinical setting (and, it must be said, provide myself with much-needed income).

I was atypical among most medical scribes, who are generally college students/graduates looking to obtain experience before applying to postgraduate medical programs, so …

How much time do physicians spend in the EHR?

Thrisha Gogineni, James G. Kahn, MD, MPH, and Sigal Maya

Physician

April 10, 2022

Doctors often find the electronic health record (EHR) time-consuming and annoying. However, quantitative estimates of physicians’ time on EHR tasks are sparse and not collated. We assembled evidence on hours dedicated to the EHR each day by physicians. The result is impressive – 4.5 hours.

A little background: EHR systems started in the late 1960s. The federal government implemented VistA in the 1970s in the Department of Veteran …

Taking courage to heart and to the heart of medicine

Joseph Fennelly, MD

Physician

April 9, 2022

Few individuals are called upon to be heroes like Ukrainian president Volodymyr Zelenskyy who, in choosing to stay and fight a massive, invading army, faces a real possibility of imprisonment and death. This is true courage.

Within the medical profession, there are also wars to be fought that require true courage. One thinks of the late Dr. Paul Farmer, who worked tirelessly throughout his career to bring high-quality health care to …

Bring back CME conferences to exotic locations

Farhan S. Imran, MD

Physician

April 6, 2022

It was not too long ago, but it seems like decades when traveling for a CME conference was a routine part of being a physician as looking up articles on UpToDate or giving patients bad news. But like so many other things in life, the reality of CME conferences has changed.

Most training programs give allowance to physicians for CME conferences on a yearly basis. After training, you have to keep …