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Physician Visibility In Public: I See Patients, And They See Me

In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me.

They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients.

The follow-up dialog between the parents might go something like this:

Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?”

Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard that he can intubate the terminal ileum in under 10 minutes.”

It’s not that I necessarily mind being seen in the wild. I’m pretty comfortable in my own skin, even when it’s glistening after a workout. I’m bothered more by the fact that patients may be repulsed by my occasional bedraggled appearance. If I knew they were good with it, I might be less caught up with the whole matter. Read more »

*This blog post was originally published at 33 Charts*

Physician Lifestyle Is Criteria When Choosing A Medical Specialty

Medical students today consider lifestyle an essential criteria when choosing a specialty. It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands. Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work and family are the ones that end up luring the largest numbers of women. Surprisingly, colon and rectal surgery is one of these, because of rapid growth in routine colonoscopies that can be scheduled in advance, giving doctors control over their time. Goldin says 31% of colon and rectal surgeons under 35 years of age were female in 2007, compared with only 3% of those ages 55 to 64, and 12% of those ages 45 to 54, reflecting the fact that younger women are flocking to the field.

Of course, what’s not said is the grueling training that it takes to become a colorectal surgeon — but the numbers cited above do not lie. The new generation of doctors — both men and women — want greater control of their time. That means more shift-work and a predictable call schedule. Read more »

*This blog post was originally published at*

Doctors And Work-Life Boundaries: Keeping An EMR In Its Place

I’ve had a longstanding policy in my office that routine prescription refills will only be addressed during regular office hours. No evenings; no weekends; if you need a refill of your long-term chronic medications, you need to call during regularly scheduled office hours, five days a week. You can leave a message if you like, but you should not expect us to call in the medication until the office is open.

The main reason for this policy has always been medical: prescription medication requires appropriate monitoring. From the moment I hung out my shingle, I’ve made it my habit always to write enough refills on your medication to last until the next time I need to see you. In all likelihood if you need a refill, what you really need is a visit.

The logical reason for the policy is the need to consult the medical record before authorizing refills. And when those records are contained on bits of dead trees on shelves in the office, there’s no way I can access them if I’m not physically there. I’ve been known to drive out to the office at decidedly odd hours for the express purpose of consulting those records so that I can provide appropriate care to my patients. That has always been the bottom line for me, and always will. Read more »

*This blog post was originally published at Musings of a Dinosaur*

When Medical Dedication Comes From Personal Pain

The old joke about psychological therapists is they are among the biggest consumers of therapy themselves. Lately, I have been noticing more and more how a significant portion of the people we meet wearing white lab coats have a very personal connection to the medical work they do. For them it is not a job, a meal ticket, or just putting their years of training into practice, it is a mission connected to something in their past, something in their own body, or the health of a loved one.

A recent example is Kaiten Kormanik. She is 23 and has had the genetic condition PKU since birth. She has to follow a strict low protein diet or otherwise risk severe negative effects on her brain. If you toured the labs of The Children’s Hospital of UPMC in Pittsburgh you might bump into her as she does research for her Ph.D. on, guess what?- genetic illnesses in children. And she often works alongside Dr. Gerald Vockley, the very expert physician who guides her care. As you can imagine, Kaitlen thinks about her own childhood and the faces of other children every day. You can hear her story on one of our recent programs.

Irl Hirsh, M.D., at the University of Washington, is one of America’s most famous diabetes doctors. He has diabetes himself and has all the challenges everyone with this disease has in managing it. You can hear his story on one of our earlier programs on diabetes. Read more »

*This blog post was originally published at Andrew's Blog*

Doctors Meet A Decade Later

I just had my ten-year medical school reunion. It’s hard for me to imagine it’s been ten years since my last medical school class. It’s been fourteen years since that first week of gross anatomy. That class was so hard, I almost dropped out of medical school after one week.

A bunch of us local docs from my medical school class of 2000 rode to academic mecca in a stretch limo. What did I learn from my experience at my ten-year medical school reunion? Other than forgetting a few names:

  • When I was in medical school, lots of medical students, on occasion, would  drink heavily. I learned ten years later some doctors, on occasion, still drink heavily and get drunk.
  • When I was in medical school, lots of medical students smoked cigarettes. I learned ten years later some doctors, on occasion, still smoke (but only when they’re drinking). Apparently.
  • When I was in medical school, some students were really funny. I learned ten years later some doctors, on occasion, are still really funny, even when they aren’t drunk.
  • When I was in medical school, some students were really smart. I learned ten years later some doctors, on occasion, are still really smart. Most of us others have been dumbed down with years of practice.

It was fun to learn about what my colleagues have been doing. Ten years later the cellphones are a bit fancier, everyone’s talking about their Facebook page, and I’m completely content sitting  on the couch with Mrs. Happy watching everyone else get drunk like it was yesterday.

*This blog post was originally published at The Happy Hospitalist*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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