The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” ...

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The constant hum of the subway car over the tracks plays in the background as I sit there with my mind running over the tasks of the day. I never quite thought of myself as a particularly intense person, yet here I was three years later working with an underserved population between a state and county hospital in my first week as one of the new administrative chiefs. The very ...

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My wife and I were in a unique situation after graduating medical school. We had met in the first year of medical school in and became friends. During our second year we started dating, and by end of third year, we were married. By the beginning of fourth year, we were proudly expecting. By June 1st, 2016 we were fortunate enough to share our graduation from medical school with our ...

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I have wanted to be a pediatrician since I was eight years old. Growing up, my favorite book was the large medical encyclopedia that sat on the bookshelf in our den. My life has been planned around that singular goal, each step predetermined and in a very specific order. I have thoroughly enjoyed practicing medicine over the last 17 years — first as a primary care pediatrician, then for the ...

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In February 2010, I completed my final ward round and said goodbye to my patients in Haiti just six weeks after a tragic earthquake. This earthquake was a natural disaster so devastating that within a momentary blink, a minute's tremor and a rumbling collapse, an estimated one-hundred-thousand people lost their lives. Amidst the wreckage, hundreds of thousands more were left severely injured, shocked, ...

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“Your zip code is a better predictor of health than your genetic code.” A picture of this quote was projected onto the screen during our lecture. Our professor’s words echoed throughout the auditorium as he described the importance of understanding the social aspects of our patients’ lives rather than just their genetic predisposition to disease. Understanding the social and economic conditions that impact health, disease and the practice of medicine lies ...

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I came into work last night for the last time. Though I was on a service full of sick patients, I was not nervous. After three years of this, three years of people trying to die in creative ways, and my friends and I trying to stop them — I have no nervousness left. There is just nothing left for the hospital to throw at me. "Dan,” I asked my intern, ...

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We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do ...

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Tom’s feet are shackled so he can’t bolt from the hospital bed when the prison guard isn’t looking. The guard places handcuffs on him when he walks to the bathroom and stands just outside the door as Tom relieves himself. Despite being treated for a deep tissue infection in one finger, Tom is in generally good shape — lean but muscular with the strong hands of a workman. Back in ...

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Can politicians fix our health care system? Sure, but they and everyone else trying will have to realize what our political leaders have voiced, but not seen that the system is complex and the truth behind Einstein’s statement that we cannot fix a broken system using the same thinking that created it. The lack of those elements is why we are still stuck. Rather than repeating the arguments of the ...

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Have you ever wondered exactly what it means when a medical student is “on rotations”? We always claim that we’re busy, but just what is it that we do all day? To answer these questions, here’s a recap of one day from my inpatient pediatrics rotation. 5:27 a.m.: I pull out of the parking lot and start the now-familiar early morning commute down I-280 to San Jose. The good thing about ...

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asco-logoI remember meeting this patient the first time. I had just started in a new position, and she was one of my first consults. Tracey* had an aggressive sex-cord tumor of the ovary that had relapsed soon after surgery, grown through primary chemotherapy and grew once more after secondary surgery and “adjuvant” pelvic radiation. I knew ...

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Regular readers of my blog know that I believe that the harms of prostate-specific antigen (PSA) screening for prostate cancer outweigh the benefits — if benefits exist at all. That isn't to say that I will not order the test in a man who understands the risks and expresses a clear preference to be screened. In a recent editorial in American Family Physician, I explained ...

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“Dr. Fraser, the pharmacy is on the phone for you. Line one.” I answer the call, pressing the gray, rectangular button with one hand while writing in a patient’s chart with the other. “Sarah Fraser speaking.” “Oh, hi, Doctor, we just got in a prescription of yours, but we are not quite sure what it says.” The pharmacist is gentle in her words. It was the first time this had happened. I’d promised myself ...

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As an American internist and expatriate in the Netherlands, I still follow the unfolding U.S. health care drama. Critics of the Better Care Reconciliation Act (BCRA) are numerous, including doctors, patients, policy experts, and the former top U.S. health administrator — even President Barack Obama. The Dutch and other developed nations must be ...

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My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!” He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with ...

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It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is ...

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I spent 20 minutes listening to Michelle and asking her questions to understand why she was not taking her insulin as recommended. The appointment was for 15 minutes, 5 of which were used by the medical assistant who had to check the vitals and “do an A1c.” I did not ask Michelle whether her feet were tingling or numb. I did not ask ...

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The impact of the opioid crisis struck home within the Missouri physician community on Dec. 15, 2014. That’s the day when, just two months shy of his 30th birthday, Derek succumbed to an opioid overdose. The news was devastating for his mother, Kelly O’Leary, a longtime volunteer with the St. Louis Metropolitan Medical Society Alliance, and her husband Timothy O’Leary, MD, a radiation ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman with type 1 diabetes presents to clinic requesting more information about use of a closed-loop insulin-delivery system (artificial beta cell). Although her HbA1c is at goal, she notes frequent hypoglycemia as an issue. In addition, she would like to further improve her glycemic control in anticipation of ...

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