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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

I never thought I'd be in a position where I would feel scared at work, but then — it happened. I started writing this piece a long time ago, far before Utah nurse, Alex Wubbels, was assaulted on camera by a police officer. It certainly reminded me to work on this again. A few years ago when I was very green, I was working in inpatient on a ...

Read more...

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 ...

Read more...

I have spent three days at the Society to Improve Diagnosis in Medicine. Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors: physician factors and system factors. We have a major system factor that can cause problems. Most hospitals in the U.S. require a diagnosis for admission. I ...

Read more...

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 ...

Read more...

“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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

Most Popular

Get KevinMD's 5 most popular stories.