“I want to explore employment opportunities with you.” He is looking at me. Trying his hardest. Passion, yet anger, in his eyes. Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is. Private practice is dying, on the vine, in America. The practices fold or reach a critical point, and they come ...

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Ladies, the moment you have all been waiting for is here!  No, not affordable childcare.  Not equal pay for equal work. Not gun control.  Not abortion rights or paid maternity leave or a female majority in Congress or a constitutional ban on the words “chick lit.”  Girls, it is so much better than all that.  We got pink Viagra! Flibanserin.  Catchy name.  Addyi for short.  Approved by the FDA for hypoactive ...

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"I'm just the night doc," you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was "just the patient," who lay suffering hours before her death and the RN was "just the nurse" withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to ...

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I just finished my first call weekend as an attending. It was a 96-hour bender. I had 4 vaginal deliveries, 1 cesarean, rounded on 20 patients on Saturday (mostly new), 14 on Sunday. I admitted 5, transferred 2 out --one for persistent ventricular tachycardia and one for a possible liver abscess, all while juggling full days of clinic on Friday and Monday. After the call, I felt tired, but still felt ...

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A few weeks ago, after feeding my face with rich, dense chocolate cake brought by a truly awesome nurse (for no particular reason other than a warm and generous spirit), I walked back into a room to check on a post-cardiac arrest patient. After surveying his vitals on the monitor, I turned my attention to two nurses and a pharmacist who were discussing the management of his six drips. He was ...

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shutterstock_124488283 As a relatively young physician, I always enjoy my conversations with the older members of our profession, who’ve seen so much change over the last few decades. I’m fascinated with their stories about how different the medical world was when they were residents, how treatments were so novel, and how they used solid clinical skills to get to the diagnosis. Those were the ...

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I have a long history with family medicine as my father was an early pioneer – heading up the family medicine program at Chicago’s Cook County Hospital in the 1970s. Even back then my dad was using physician assistants (PAs) -- many of them former military medics in the Vietnam War era -- who were part of what was at that time a brand new profession. Family medicine as a whole ...

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“A good surgeon has the eye of an eagle, the heart of a lion, and the hand of a woman …” – 15th century English proverb #ILookLikeASurgeon, a hashtag on Twitter and the movement it has inspired, has resonated deeply with me. I look like a surgeon. There is so much more behind this seemingly simple statement of fact. I am not just stating that I have excelled and I have achieved and ...

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Dr. Google has been the brunt of numerous jokes and various denigrations from the medical community for some time.  The most recent such offering to come to my attention was from Tanya Feke who seems to want Dr. Google sued for malpractice.  As one who was instrumental in the construction of the Internet, which allowed the creation of Dr. Google, I read these attacks with mixed emotions.  I ...

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The vast majority of physicians enter medicine with an inborn sense of compassion. Junior residents, however, are the logistical workhorses of teaching hospitals — their north star is efficiency and they are measured largely on their capacity to “get things done.” The consequence is often a slide towards unwitting apathy. I, like all residents, have witnessed this reality first-hand. By reflecting on my experiences, I hope to discover insights we ...

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The job of being a doctor can sometimes be like that of your favorite sidewalk juggler. It used to be that a good family doctor would have to show up in the clinic for a couple of hours, make a few house calls, and be available if anyone needed him while he played a round of golf in the afternoon. (Really, this is quite an exaggeration but it sets the ...

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About a year ago, I wrote a piece on my blog called “How to Welcome Incoming Residents.” It was about my struggle with getting the right messaging, messaging about the reality of stress during residency and the necessity of incorporating self-care and outreach to others. This year at orientation, in addition to adding the great suggestions posted by readers of the article, I took a different tack. It ...

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unnamed Heath care documentation is done for three reasons:

  1. health care delivery (that’s the obvious one)
  2. regulatory compliance (checking all the boxes our government and payers think are important)
  3. malpractice avoidance (no one wants to get sued)
These three categories actually apply to every task we do in health care, but let’s confine this discussion to documentation. Note in the accompanying figure, our three basic health care work ...

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“This is our sickest patient,” my co-intern began as she told me about one of her patients I would care for overnight. It was my first week of intern year, and I was assigned the overnight cross-cover shift for a busy cardiology service. Introducing myself as “Dr. Tredway” still rolled awkwardly off my tongue, but I had grown more comfortable throughout the week in my new role as a physician. ...

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shutterstock_137913404 1. Be nice to others, even if there are a lot of butt sniffers out there. 2. Waiting to be seen is really hard. Try to keep a schedule and routine. 3. Get out for that walk. It will fill you with joy, well-being and makes the rest of the day calmer. Take other dogs on that walk to improve their well-being too. 4. “Good ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena. On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse ...

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“If he is hungry when he wakes up, and you don’t let him eat, we’re taking him to another hospital,” the man shouted. I stood trapped between a protective papa bear and his cub. My instinct was to find an exit, but I braced myself for more. This father gave me one last glare before side-stepping around me and wrenching open the door to his child’s hospital room. I glimpsed ...

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I read a fascinating article from ProPublica about a nurse practitioner (NP), Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, the payments ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I love pre-visit planning. OK, “love” may be too strong a word -- I like pre-visit planning. Pre-visit planning isn’t new. Many of you have done it for years, even before it had a name, for example when pre-ordering labs before a visit. I did not begin ...

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This article was originally written on August 11, 2015. My psychotherapy supervisor taught me a tip during residency: to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session. (Because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning.) I struggled to come up with a topic to ...

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