How a cancer patient impacted her oncologist
The day after I told Nell she had seven metastases to her brain, she sent me flowers.
She was my patient; I was her oncologist. I had met her one year prior, when she was well into her cancer journey, stage IV breast cancer at diagnosis. I took over from her current oncologist, who was moving. At our first visit together, she grilled me without mercy. Her questions were insightful, and her demeanor was tough; I liked her immediately. I must have passed her test because she returned to see me again.
One hour was never enough time in the clinic. Her questions always had a twist I never thought of. I enjoyed our high-level co...
Source: Kevin, M.D. - Medical Weblog - April 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jennifer-lycette" rel="tag" > Jennifer Lycette, MD < /a > Tags: Physician Cancer Source Type: blogs
Face it, doctors are bad leaders
As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we don’t know that we don’t know that we don’t have it!
What defines leadership? Leadership can be defined by many principles including influence, change, character, service and development. However, the principles of leadership have a commo...
Source: Kevin, M.D. - Medical Weblog - April 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/maiysha-clairborne" rel="tag" > Maiysha Clairborne, MD < /a > Tags: Physician Primary care Source Type: blogs
“I hate myself. I don’t deserve to be a doctor.”
Dear Dr. Wible,
We’ve talked before. To catch you up, I’m in my clinical years now and I keep waiting to feel the same starry-eyed excitement I felt during the first months of med school, when I thought that becoming a doctor would finally give me a tangible purpose and make me a better person by helping me do right by others in a way that is meaningful. Back when I thought “Yeah! This is awesome! I can do this!”
In hindsight that was naive. I went in hoping to develop into this clever, proactive, healthy, and well-balanced physician by the time I graduated. But what ended up happening was that I became obese, star...
Source: Kevin, M.D. - Medical Weblog - April 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/pamela-wible" rel="tag" > Pamela Wible, MD < /a > Tags: Education Medical school Source Type: blogs
5 things I learned while having 3 kids during medical school
During medical school, I made it a goal to graduate with a degree in one hand and a baby in another. I had a supportive husband, so we started trying to conceive when I was in my third year of medical school. We didn’t get pregnant as quickly as I thought, and we almost gave up on the idea of having a baby at that time. I was already 28 years old, which I didn’t think was too young, and I had already been married five years.
Anyway, we stopped trying to have a baby and my girlfriend and I took a trip to Costa Rica for spring break. It was such a beautiful magical place, with the lush rainforest, green mountainsides, no...
Source: Kevin, M.D. - Medical Weblog - April 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/habiba-tunau" rel="tag" > Habiba Tunau, MD < /a > Tags: Physician OB/GYN Residency Source Type: blogs
Chewing gum to detect cancer? Not so fast.
Sometimes It’s important to know the news behind the news: the comments and the cautions that don’t get into the article that the public gets to read. It’s the sort of thing that keeps me up at night: trying to convey the reality, while realizing what most people want to hear is the hope.
That’s the problem I have with a story posted on a major news network website recently, where I have a brief quotation that failed to capture the thoughts I tried to express at the time of the interview. The reporter had very limited time, and the information I wanted to provide was complicated. Instead of the caution I tried to c...
Source: Kevin, M.D. - Medical Weblog - April 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/j-leonard-lichtenfeld" rel="tag" > J. Leonard Lichtenfeld, MD < /a > Tags: Conditions Cancer Source Type: blogs
Doctors need to become informed physician investors
D.J. is a 55 year-old woman with recently diagnosed early-stage left-sided breast cancer. She just had a lumpectomy to remove the tumor, and now has to decide whether to undergo chemotherapy after surgery. Her oncologist carefully discusses the clinical and pathologic data about her tumor, in terms D.J. can understand. She discusses the risks, benefits, and side effects of chemotherapy, and recommends treatment. D.J., having learned about the risks and benefits of chemotherapy online, in pamphlets, and from other breast cancer patients, asks her oncologist additional questions about the chemotherapy. After an extensive dis...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/wall-street-physician" rel="tag" > Wall Street Physician, MD < /a > Tags: Physician Primary care Source Type: blogs
Note to Congress: It ’s your fault there’s a physician shortage
When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming.
In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly 3,000 percent, fewer students are entering medical school. In fact, according to Compdata Surveys, hospital administrators now account for a large proportion of the costs of health care.
The impending physician...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kevin-r-campbell" rel="tag" > Kevin R. Campbell, MD < /a > Tags: Policy Heart Source Type: blogs
The hardest thing to do as a physician
I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for the first time. Although I find myself in a similarly intimidating and burdensome position of addressing the loved ones of our gracious donors tonight, for my first time, I feel great relief that I do not have to experience either of those things I just described. Instead, I have the rare privilege of delivering news that I hope will make loved ones feel proud, even in the wake of loss, by recognizin...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kitae-chang" rel="tag" > Kitae Chang < /a > Tags: Education Medical school Source Type: blogs
Top 5 reasons why doctors lack self-confidence. And how to fix it.
In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.
What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical students and doctors: It’s not your fault. Here’s why you are suffering and what you can do about it.
With decades of experience helping people break trauma bonds, overcome destructive thinking patterns and transcend t...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/pamela-wible" rel="tag" > Pamela Wible, MD < /a > Tags: Physician Primary care Source Type: blogs
The dangers of being overly apologetic
“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.
“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave of calm flooded the room, and the pace slowed. As I was putting away the laryngoscope, I asked the nurse, “Was I too bossy?”
Sorry is a crutch: a filler word. A way to politely ask for something without offending, to appear...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/theresa-hsiao" rel="tag" > Theresa Hsiao, DO < /a > Tags: Physician Emergency Source Type: blogs
If she gets pregnant, she might die. Do I help?
When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties such as mine, where blood transfusions are always a possibility. Because my first job was at the hospital where I trained, I didn’t think of seeing Jehovah Witness patients as an “i...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/andrea-eisenberg" rel="tag" > Andrea Eisenberg, MD < /a > Tags: Physician OB/GYN Source Type: blogs
Shared medical decision making is a not a new concept
Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient — as opposed to the doctor — as the driver of medical decision is, quite curiously, just beginning to be recognized in a model called shared decision making.
Shared decision making is the process between a health care professional and patient to help the patient decide between several medically reasonable choices based on the pat...
Source: Kevin, M.D. - Medical Weblog - April 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/stephen-devries" rel="tag" > Stephen Devries, MD < /a > Tags: Physician Heart Source Type: blogs
The cruel irony of the Hippocratic Oath
In a few weeks, new medical school graduates will take their turns saying the words of the Hippocratic Oath.
In theory: This is a noble tradition where they promise to fulfill their duties as wonderful physicians: Autonomous, wise, humble, prevention-focused, and active members of their communities.
In reality: The health care system in which they’re entering makes it next to impossible to keep any of these commitments. It is a cruel irony to have medical students pledge their commitment to preventive care as they enter a world dominated by tertiary medicine.
But here’s the thing: I don’t want to change the Hippocrat...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jamie-katuna" rel="tag" > Jamie Katuna < /a > Tags: Education Medical school Source Type: blogs
A hospice worker says goodbye to a loved one
“Why don’t you talk loud enough for the whole damn hospital to hear you?”
I’ve just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma’s room.
The nursing assistant whfo showed me in glares across the curtain at the other inhabitant.
“You shut up,” she tells the person firmly, “or I’ll smack you with a bedpan.”
Then, she leaves us alone.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media ...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/scott-janssen" rel="tag" > Scott Janssen, MSW, LCSW < /a > Tags: Patient Palliative care Source Type: blogs
You ’ve heard of Brexit? Here’s what they call doctors who are leaving.
Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance.
Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.
Once DRexit begins, there will be no turning back.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is destructive to the physician-patient relationship because it prevents physicians from prioritizing patient care. MACRA supporters like ...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/niran-s-al-agba" rel="tag" > Niran S. Al-Agba, MD < /a > Tags: Policy Primary care Source Type: blogs
