We all know what, in 1888, Rudyard Kipling pronounced to be the world’s oldest profession. But what’s the world’s second oldest? Hunter-gatherer? Nah, everybody did that. Primitive politician? That’s a tautology. Neolithic attorney? Nope. Too similar to the oldest. I strongly suspect that the second oldest profession was healer/magician. Fire up Mr. Peabody’s Wayback time machine, and you’d probably find that the first healers were regarded as magicians, and the first ...

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Rates of physician burnout are rising, and many physicians cite their electronic health record (EHR) as the primary culprit. That’s no surprise, since doctors spend twice as much time on electronic health record (EHR) systems and deskwork as they do directly interacting with patients. Let that sink in for a moment. Imagine if an airline pilot spent six hours documenting every detail of a three-hour flight. Such ...

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Something very interesting happened to my patient visits when I changed my office attire. My clean long cotton lab coats, hanging on the back of my office door, suddenly all seemed dingy when I set out to change lab coat about a week ago. I decided to pretend it was Saturday. On Saturdays, I usually wear a pocketed button-down shirt instead of one of my usual Jermyn Street ones. I skip the ...

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According to Wikipedia, "Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations." Please tell me how this relates to being a physician or a patient.  We do not produce anything.  Rather we work with individuals to ...

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The invitation was unexpected. Although I would attend the conference as a relatively new member of the community, I knew I was making inroads, so I accepted without hesitation. The prospect of meeting well-established players in the field at dinner with the planning committee was exciting. And, I was equally looking forward to spending more time with a fellow newbie who had already been tapped as a rising star the ...

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No one needs to know the value of multitasking more than a physician. At any point in time, we have to juggle a myriad of tasks and obligations. As a younger physician, I was able to recall multiple requests and obligations without writing them down. As I have grown older and the memory is starting to fade, I find it necessary to ...

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We humans can’t help but shove as much as possible into one minute, one hour, one day. We’re rewarded for doing it, too. Society says that the more you check off your list, the more productive you are. And by default, then, the more productive you are, the more successful you are. So, we rush. We search for ways to skip steps and still get the same result. We fill ...

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Most parents have been deeply distressed by the rising violence and streams of hate as a keynote in our national discourse. For a constructive response, I encourage parents to write to their school administrators and partner with the adults in their children’s community to stem the tide of vitriol that has engulfed our views on race, religion, and the study of history in our everyday lives. Here is an edited ...

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That first paycheck as a new attending means so much more than what is direct-deposited into the bank account. The emotions of finishing medical school and training to finally seeing the fruits of your labor positively affect the bank account is something to be proud of. As a medical student (like myself) and resident, it is the light at the end of the tunnel. You’re probably asking yourself, “Why should ...

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After almost fifteen years as a research physician, I grew tired of the relentless cycle of applying for grants, failing to obtain funding, and reapplying with variable success. Conducting clinical trials was rewarding, but the responsibility seemed endless. I began to feel burnt out, scorched. It was time for a change. I needed a hobby. Around this time, I read Frank McCourt’s memoir, Angela’s Ashes.  The author described it as a story ...

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Is the practice of medicine a different experience for male and female physicians? Two recent studies from athenahealth suggest that it is -- in ways that should make us rethink what we value in health care. The first study found that male physicians are more productive than their female counterparts. In an analysis of 47 million visits on the athenahealth network in 2016, male physicians generated 30 to 40 percent more ...

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I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time.   During that time I stayed in a lot of hotels.  But, occasionally, I had more unique accomodations.  Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal.  I actually like sleeping in airports occasionally.  When you’re stuck, you’re stuck.  Weather or ...

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One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed.  The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today. Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are ...

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Let me start by saying that I am a huge Dave Ramsey fan.  When I completed residency and began my current position, The Total Money Makeover was the first personal finance book I read, and pardon the cliché, but it changed my life.  It instilled in me a strong foundation in money management and offered me a road map to handle the situation I was in: hundreds of thousands of dollar in ...

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When my husband Brian started first-year of medical school at the University of Miami Miller School of Medicine, I jettisoned off to Thailand to spend a year teaching English and traveling.  We figured if we were going to date long-distance, why not go all in? Why not ensure that we were a full 12 hours apart, on literal opposite sides of the world. What can I say? We like a ...

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In this current era of health care, patients are increasingly being labeled as “customers” to provide a landscape suggestive of the need to provide customer satisfaction. Many health care providers grow increasingly frustrated with that terminology. It demeans the relationship that is fostered in the patient-physician encounter; belittling it to a transaction that occurs as the exchange of goods for an expected outcome. Perhaps a more appropriate corollary to the ...

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Next month when our youngest child leaves for college, the biggest change may not be in his life but in ours. We are done with dropping them off at school, or giving them driving lessons, or helping them with difficult homework assignments: We will officially become “empty nesters.” My wife and I ponder sitting at the dinner table and standing by the kitchen counter, where exuberant political dialogue takes place, and common ...

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Approximately 12 years ago, I hired my first physician in recovery. He had temporarily lost his license following a bout with alcohol. After a stint in a rehabilitation clinic, he was ultimately reinstated. My journey to hire this physician was arduous at best. During the interviewing process, I narrowed the field down to two candidates: one with a past and one without. I wrestled with the “in recovery” situation and ...

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Yesterday, we had a meeting about leakage. No, it was not about urinary or fecal incontinence, but it was about care that could have been provided within our institution that ended up, for a multitude of reasons, happening with providers beyond the walls of our institution. Representatives from our accountable care organization had requested a meeting to go over some issues they've been having with our practice, including low levels of usage ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. In April, the American College of Physicians (ACP) released a position paper titled Putting Patients First by Reducing Administrative Tasks in Health Care, published in the Annals of Internal Medicine. The paper, part of ACP’s Patients Before ...

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