“Liver Transplant Surgeon Addicted to Alcohol” -- reads like a headline from a tabloid paper selling sensationalism. How could it be? How could a liver transplant surgeon, someone who sees up close and personal the devastating effects of alcohol on the body, be addicted to alcohol? Surely the diseased, fibrosed, hard, shrunken cirrhotic livers with dilated and engorged veins that can rupture and bleed catastrophically; the yellow eyes and skin of the ...

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Today is a remarkable day for me. I’m officially leaving private practice after almost 18 years, to return to academic medicine with a faculty position in a highly regarded California department of anesthesiology. Why would I do that? There are many positive reasons. I believe in the teaching mission of academic medicine:  to train the anesthesiologists of the future, and the scientists who will advance medical care. I enjoy teaching. The years ...

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In 2012, celebrated surgeon-cum-writer Atul Gawande penned an incisive essay for the New Yorker entitled “Big Med.” Deliberately provocative, yet disarmingly reasoned, it suggests that American health care should borrow management practices from the Cheesecake Factory. To set the stage, Gawande paints an unflattering picture of the status quo: medical costs are too high, quality is not reliable, service is often poor, and physicians differ widely in their approaches and outcomes ...

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An excerpt from Beyond Embarrassment, reclaiming your life with neurogenic bladder and bowel. Conceivably one of the areas of life most affected by neurogenic bladder is sexual intimacy. When I was first diagnosed, I was afraid to have sex. Because I was new to using a catheter, I was sore ...

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Burnout, burnout, burnout.  It seems like that is all anyone wants to talk about these days.  And I admit, some days, I can get burnt out on burnout.  But, all the attention on the subject got me thinking.  Did burnout not exist 30 years ago? Why is this such a hot topic now? And that is what brings me to this post; I came to the realization that burnout very much existed ...

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Many of us who suffer from chronic pain and illness are on medications that carry side effects that, in some cases, can be as difficult to cope with as our initial health problems. I’ve recently started a medication that I’m scheduled to be on for five years. I’m taking it because it significantly reduces the risk of a recurrence of my recent bout with breast cancer. And so, yes, I’m taking ...

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Foria wants you to know they are selling vaginal suppositories of THC (tetrahydrocannabinol) and CBD (cannabidiol) called Fiora Relief for menstrual cramps. Each suppository contains 60 mg of THC and 10 mg of CBD. Foria claims they can treat the pain of menstrual cramps and endometriosis. Is this possible? THC and cannabidiol (CBD) are compounds found in marijuana. The psychoactive (i.e., high) from marijuana is believed to be due to the ...

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In a few weeks, thousands of medical students find out where they have matched for residency. I still remember the excitement and anxiety of peeling back that envelope and hoping I would see my top choice. My medical school had a tradition of putting each 4th year’s name in an old doctor’s bag. One by one, our dean would pull out a name, the student would contribute $1 to the ...

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When I started my first internship, back in Sweden in 1979, I worked under a fifty-something cardiologist who spoke slowly with a southern drawl -- yes, there is a southern drawl there, too, slightly reminiscent of Danish, spoken not far from where my supervisor grew up. He epitomized the old school of cardiology, before it became a procedural specialty. He diagnosed heart murmurs by auscultation with his stethoscope, and he even ...

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Quick: Which U.S. state has the highest rate of unintended pregnancy? I’ll reveal below, but I learned the answer and several other surprising facts in an interview with Mark Edwards, the co-founder of Upstream USA, a non-profit advocacy organization that provides technical assistance to health enterprises (medical practices, clinics, public health departments) in the use of long-acting, reversible contraceptives (known in the trade as LARC). LARC consists of two options: ...

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ZDoggMD's latest parody: In Da Lab. Show some love to your lab techs! Where would clinicians be without them?

I felt like the stack of charts rose past my head and all the way to the ceiling.  I pulled out my pen, opened the first, and started charting.  I took a moment before each note to collect my thoughts.  The patients were complex, the problems sometimes insurmountable.  The nursing station at the facility was buzzing with activity around me.  Phones were ringing, alarms were crying for attention. On the desk ...

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Many hospitals around the nation have been stung by dreadful physician engagement scores. Engagement is a problem not only for demoralized physicians, but for health care organizations, their employees, and everyone they serve. They should take note, because low levels of engagement are associated with higher physician turnover, increased error rates, poorer rates of patient cooperation in treatment, and lower levels of patient satisfaction. Definitions of engagement vary, but it generally ...

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Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments.  Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing ...

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It’s been six years since I graduated from internal medicine residency. Enough time to give me some perspective, but short enough to still remember the highs and lows vividly. I recently had the opportunity to talk with a bright and energetic group of medical students. (Really, though, is there any other kind?) The conversation turned to any advice that I had or maybe I felt obligated to give some as part ...

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I find myself standing in front of six first-year medical students. They’re waiting for me to tell them something about how to become a physician entrepreneur. These students are now elite amongst their peers. They’re the ones who’ve had the courage to sign up for my course. And, perhaps unbeknownst to themselves, they’re also among the 1 percent of early adopters to lead the way for health care change. How do I ...

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All hopes were abandoned.  In theory, it was supposed to jump start medical care and provide access to the uninsured.  It was the promise of a new day. Every American would have access to good, quality (I really have learned to hate that word), affordable medical care. I’ll never forget that day.  It was raining hard, and my clothes were soaked through. The air felt particularly raw against my skin. The ...

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I was dining at a friend’s house recently after a long day in the hospital. He has just bought a beautiful new home with his rapidly expanding family, and like anyone who has just moved into a new house, his spare time is invariably spent working on getting everything in order and undertaking small upgrades to make the new place as perfect as possible. He’s quite DIY-oriented (unlike myself) and was spending a lot of ...

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It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor. For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis?   The chest ...

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Supply chains and other service industries, like telecom, worry about "the last mile" -- the final step in delivering a product or service to customers. Like other industries, health care must connect most meaningfully to the patient, and the nurse is almost always part of (if not the sole manager of) that last mile. The analogy of the last mile defines a deeply rooted issue about nursing’s criticality (and that ...

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