A quintessential art of communication is a well-written note. A decent note is one that is self-explanatory as you read. However, to read, you need to understand what is written, and decent handwriting is vital. Unfortunately, neat handwriting is something tough to find, especially when the writer is a doctor. While doctors may be the smartest students in their class with gold medals around their necks, immaculate in appearance, polite in ...

Read more...

“It should be in my chart.” I’m sure we have all heard this statement uttered with a subtle (or not so subtle) edge of frustration from our patients after asking a question such as “what medications do you take?”  I find clinicians despise this comment because it is interpreted as (a) the patient is not making an attempt to recall his or her medical history, or (b) that the patient doesn’t ...

Read more...

In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment ...

Read more...

It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And ...

Read more...

Physicians and nurses deal with the deepest issues of the human condition: life and death. Our profession brings new life into the world and does our best to bring comfort and peace at the journey’s end. It is a profound and emotional experience for medical professionals to be with a patient and family when life ends. There are other professions who routinely confront loss of life. Law enforcement personnel, paramedics, firefighters, ...

Read more...

Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets." I told him not to worry and that we understood and that "these things do happen." His response has stuck with me: "Doc, but there is still some shame." I nodded, told him not to worry since he was going to get a catheter anyway, ...

Read more...

I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night. So, what’s harder: medical school or law school? Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training. The other most ...

Read more...

As physicians, we are constantly faced with a daily barrage of meeting minimum RVUs, while keeping up with EMRs as part of the necessary components to successfully practice medicine. This has resulted in a decrease in personal interactions with patients, which has caused an increase in physician burnout and suicides. Attempts to reverse these negative impacts have resulted in instituting wellness and meditation clinics and debriefing after traumatic clinical events ...

Read more...

A 69-year-old man with a medical history of hypertension, diabetes, and obesity with a body mass index of 33 was admitted with altered mental status. He and his wife were returning from a 14-day Alaskan cruise. On their return, the wife started noticing that her husband was behaving strangely and acting forgetful and had short-term memory loss. This gradually progressed to generalized confusion and altered mental status leading him to ...

Read more...

What is your gut reaction when you hear the words "hospital chaplain?" Maybe it's an eye roll or confused stare about what you believe to be an incoming attempt at religious conversion. As a family member anxious about a loved one in the hospital, maybe it's a sigh of relief. As a patient, maybe it's an overwhelming fear of incoming bad news. Health care chaplaincy is chronically misunderstood, beginning with ...

Read more...

Residents and fellows around the country have bought into the "medical training myth." The myth states: "Life will get so much better when I finish residency/fellowship." Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate. Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been ...

Read more...

I have just finished another round of that dreaded process that we call “the interview process.” Without fail, this process has haunted me almost cyclically every 3 to 4 years in the last 11 years of my life. First, there were medical school interviews, residency program interviews, and then lastly, fellowship interviews. You would think that after so many rounds of applying, it would get easier. You would think after I ...

Read more...

In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse ...

Read more...

The doctor shortage across the United States is coming and has the potential to be painful to millions of Americans. According to the Association of American Medical Colleges, by 2023, the country may experience a deficit of up to nearly 122,000 physicians. With more and more Americans getting access to health care because of policies like the Affordable Care Act and Medicaid expansion, and with the aging population, medical schools ...

Read more...

The day began in Mom's room with a 10:00 a.m. conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my 93-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself. Mom was on high-flow oxygen therapy delivered through a nasal cannula. Despite this, her blood-oxygen levels were well below normal. Clearly, her lung function was declining. ...

Read more...

Though I owe a debt of gratitude to all of my internal medicine attendings, none of them can claim credit for getting me through the gulag of residency. That distinction, instead, belongs to Zubin Damania, alias ZdoggMD, an internist and purveyor of viral YouTube music videos.

I first became aware of Damania’s videos when a med school friend sent me a link to his online archives, resulting in one ...

Read more...

With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it. Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and ...

Read more...

If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes. Is this proper ...

Read more...

I am a cardiac anesthesiologist. I meet most patients I care for minutes before I take them to the operating room and render them unconscious. I breathe for them, administer pain medicine and drugs to give them amnesia, and I keep their hearts, lungs, kidneys, and brains working. Pretty important stuff. I want to speak on behalf of physicians. I want all patients to know something: We need you to talk to us. We ...

Read more...

Nurses are the very heart of health care. These wonderful professionals work tirelessly for the good of their patients, spending the most time with them and often being their biggest advocates and best friends during what is a frightening experience in the hospital. In my career, I’ve worked with some truly magnificent nurses, who would be an asset to any organization. Every practicing doctor has also been in situations where it’s ...

Read more...

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.