I’ve finally found my groove with our EMR. Maybe I’m even starting to like it. A few weeks ago I got a new iPad, this time a Mini, which lets me type with two thumbs the way some people text on a smartphone, and the voice transcription is good enough as long as you avoid fancy jargon and unusual generic drug names. Yesterday as I sat next to a patient and ...

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My first memory of encountering a person who appeared to have no place to live was during my first year of college at UCLA. A man was sitting outside a mini-mart, his legs crossed and his hair long. He looked tired, and his clothes had stains on them. Feeling pity for him, I went into the mini-mart and purchased a turkey sandwich on wheat. “Here,” I said as I handed him ...

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One of the most important things my mother taught me was to choose my friends intelligently. From a very young age, I remember my mother quoting Proverbs to me and telling me this, “Choose your counsel wisely.” The older I get, the more I believe who I allow to influence me plays an enormous part in the place I find myself in today. Research has shown you become like the five ...

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Flu vaccines are available, and so that means that the anti-vaccine brigade is out in force. The Daily Mail published an anti-vaccine op-ed by a former reality TV contestant named Katie Hopkins. It was followed by a shorter counter argument by a doctor, but when you are given less than half the word count and are at the bottom of the page it is hard to mount an effective response. Hopefully ...

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According to recent Ohio statistics, 1.3 million people have limited or no access to primary care physicians. Based on the 2015 Ohio Primary Care Assessment, 60 of 88 Ohio counties have medically-underserved populations. The Patient Access Expansion Act (HB 273), co-sponsored by Representative Theresa Gavarone (3rd District) and Representative Terry Johnson (90th District), specifically addresses health care access by prohibiting physicians from being required to ...

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Dear patient, I meet people several like you on a daily basis. It is always a pleasure to meet you since you come much more prepared compared to the average patient. I have seen you with several sheets of paper or even a notebook, a list of questions and an extra sheet of paper on which to write recommendations. You may even have printed research papers and articles off the Internet. I ...

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Text message: Me: “Mom you alright? I just heard that there was an explosion at the Pepsi Center.” Mom: “What are you talking about? I am fine, everything is OK over here.” Earlier that day: It’s the first day of my first ER rotation as an intern. I had endured months on medicine, neurosurgery and the medical ICU. I am finally home back in the ER. I am hoping that today will be a somewhat ...

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For days on end, she looked out of the bedroom window, rocking her baby back and forth on her glider. The maple tree waved at her daily as the breeze came through its branches. Gradually, the leaves made their annual change from green to red and orange and yellow. She watched as the leaves transformed, jealous of their seamless change as she struggled to make her own transition to motherhood. Eventually, ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. For this column, my 61st for the American College of Physicians (ACP), I thought it would be interesting to look back at the first 60 and review the trends and topics that inspired me to write 800 to 900 words every month. Rather ...

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This is a letter I wrote to my wife’s grandfather for Veterans Day back when he was still alive.  He was pretty proud of it, and that made me smile because I knew that if nothing else, he deserved to be proud of what he did for America.  When he died a few months ago, I was able to muster up the fortitude to read it at his funeral.  Here ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has ...

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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 ...

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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 ...

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The 2nd Annual Women in Anesthesiology Conference is taking place in October. Developing this organization has been a labor of, if not love, then honoring. We are honoring a value system that works to gives women the respect, autonomy, and power they deserve. There is an amazing power in gathering, shared experiences and decreasing isolation. Nobody has identical life experiences. But part of what informs our identity is shared experiences. As ...

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For its many users, health care’s fee-for-service reimbursement methodology is like an addiction, similar to gambling, cigarette smoking, and pain pill abuse. Doctors and hospitals in the clutches of this flawed payment model have grown dependent on providing more and more health care services, regardless of whether the additional care adds value. I don’t use this metaphor lightly, nor wish to trivialize our nation’s growing problem with addiction. Rather, as a ...

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I am not a curmudgeon, but I am worried about the current plight of health care and the attack on the Hippocratic Oath. Bigger health care is sold as better and more efficient with the premise of lowering health care costs. The promised financial outcomes and efficiencies for the physician and their patients have not materialized. Instead, while physicians struggle with non-clinical demands on their time, patients are being pushed ...

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In her recent New Yorker article, “The Sorrow and the Shame of the Accidental Killer,” author Alice Gregory claims there are no self-help books for anyone who has accidentally killed another person.  Nor published research, therapeutic protocols, publicly listed support groups, nor therapists who specialize in their treatment.  She profiles several such tormented souls who bear their burdens largely alone. Yet dealing with guilt, shame, and regret is a mainstay of ...

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I really like Van Morrison.  If I need to be lifted up on a Friday afternoon I'll play a greatest hits album and will quickly be smiling.  One of my favorite songs is Days Like This. You would expect when someone says "there will be days like this," they are complaining about days when everything goes wrong and you just have to endure to the end, hoping that "the sun comes up ...

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Recently, a video went viral when a woman complained about the lengthy wait time at a clinic.  On video, we see the physician asks if the patient still wants to be seen.  The patient declines to be seen, yet complains patients should be informed they will not be seen in a timely manner. The frustrated physician replies, “Then fine … ...

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As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark.  At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job.  Unfortunately, the parental vaccine hesitancy trend is gaining in popularity.  Studies have shown when pediatricians are specifically trained to counsel parents on ...

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