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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shutterstock_104930039 There was once a little boy who loved to draw.  He would wake up every morning, pull out his box of colored pencils, and let his hands explore the promise of a pristine sheet of blank paper.  For him, the canvas was anything but empty,  images and ideas exploded out of his mind and magically appeared on the pages in front of ...

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A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles evaluated. This is nothing new, but it looks to me like there are increasingly more of these articles which celebrate products and fewer interesting articles about the science of medicine. The other thing ...

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I have a confession to make: I sometimes look forward to my trips to the bathroom at work. Being a busy pediatrician, it can be the only alone time I get to myself; and on occasion you just need a quiet place where babies aren’t crying, and phones aren’t ringing. The other day as I was leaving the bathroom and returning to the bustling clinic, I did something strange. I ...

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I was an overachieving, well-rounded and sagacious undergraduate student. I majored in psychology, minored in biology and was an active member of the Psi Chi honor society. I was drawn to the study of psychology, and fascinated by the complexities of mental illness. I became certified as a research assistant and spent many hours with severely depressed individuals, who had become crippled by their illness. I was intensely intrigued by ...

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photoshoot-770x457 Have you ever had a professional photo shoot? I have had many, but not because I particularly enjoy being photographed. Actually, it is quite the contrary. Photo shoots have always been a traumatic experience for me. You see, for some reason, likely as a creative form of cruel parenting punishment, my family of five siblings had a photo taken every year while growing up. ...

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“Dr. Gunter, I think, uh, there’s a fetal skull in the abdomen,” my resident said with that hesitancy that says I want you to tell me I’m wrong. The first time you diagnose something that is very bad you actually hope you are mistaken and want someone more senior to reassure you that you are overreacting and tell you that this is just an odd presentation of something benign. “I’ll be ...

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asco-logo "Why did this happen to me?" That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to “avoid” cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if ...

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asco-logo One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day. With the exception of the new patients on my schedule, I recognized all of the names on my list. I opened the electronic chart of the first patient to skim the problem list, a handy spot where I ...

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growth-in-administrators_opt I’m taking back medicine. If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed. Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots ...

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Being a doctor is one of the most emotionally and physically demanding professions out there. The health care landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that being a doctor was “the most challenging of jobs,” and ...

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shutterstock_284306441 How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for ...

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Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy. First, a healthy donor must be identified.  The donor ...

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When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night. Shift work, especially overnight shifts, has a way of inflicting sneaky havoc upon the body and minds of the delusionally hearty. After twenty years as an emergency physician, I should know better ...

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shutterstock_159719039 This past March, thousands descended on Austin, TX, home to the famous and much celebrated South by Southwest (SXSW®) conferences and festivals. This year, I decided to attend the education-focused festival, SXSWedu®, a relatively new addition to the SXSW® family of events.  A four-day conference chocked with interactive workshops, panel sessions, and even play summits, SXSWedu® is designed to showcase the creativity ...

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One theme has gripped the collective conscience of the nation for the last year. One theme has connected Ferguson, Missouri, to Staten Island, New York, to Charleston, South Carolina. One theme has destroyed neighborhoods, incited riots, and terrorized churches. That theme is racism. Unfortunately, it’s also found a way into our health care system. Black and white In 2003, the Institute of Medicine (IOM) released a groundbreaking report stating African-American individuals ...

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Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare ...

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Have you ever been a patient? Yeah, me too. Many newly insured Americans will visit doctors’ offices this year. The average time you -- or anyone -- has with a primary care provider is 15 minutes. What’s a sick person to do? Happier patients make happier doctors. Here’s a helpful list that I’ve developed to help patient visits go smoother: 1. Pick three questions or concerns that you have for your doctor and write ...

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Smitty greets Sully as they meet to head to work, “Hey there, Sully! How’s your wife?” Sully answers, “Oh, geez. She’s up in bed with laryngitis.” Then Smitty says, “Laryngitis?! That damned Greek!”
As you may have guessed, I am nursing a case of laryngitis, my voice muted and strained. This time, it has not stopped me from attending to my work responsibilities or other activities. It has required some adjustments though, ...

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