Dostoevsky's Brother's Karamazov cleverly spoofs the careless inexpertness of what often passes for expert legal testimony. Three medical experts are called to testify whether Dmitri Karamazov was sane or insane when committing the alleged murder of his father. Naturally, the experts all disagree, with each completely convinced of the incontrovertible truth of his own opinion. Expert 1 finds Dmitri insane because he looked to the left as he entered the courtroom. Expert ...

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We are often our own worst critics. Whenever doctors feel down, or burned out in our roles as health care providers and healers, we look inward. We wonder what is wrong with us. What could we do differently? We wonder why other doctors don’t have this problem. The truth is, we do. We all do. And yes, sometimes the problem is within us. But other times, the problem is outside of us. Sometimes, it’s ...

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Almost every practicing doctor remembers the grueling hours and intense workload of residency.  I recall overnight calls when I ran around from floor to floor, my beeper never stopping. I would collapse at home the next morning exhausted, drained, and a little depressed.  I would never want to relive residency, but I do look back at it with a sense of accomplishment.  In some ways, it is a badge of ...

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I can recall, though it seems quite long ago, my first basic life support (BLS) course as a first year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly,  “Sir, are you OK?” Then hearing no response she showed us how to check for a pulse and spontaneous breathing. “If ...

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I’ve wanted to be a physician for as long as I can remember.  As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics, and helping others.  Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities. For fifteen years, I lived, breathed, and worked toward my goal to become a pediatrician. In college, I studied ...

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Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The idea is that patient anxiety while waiting to find out a test result could be alleviated by an immediate discussion with a radiologist. That would be very nice, but there are potential problems, some of which are detailed in ...

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A doctor wants to leave medicine to sell Tupperware A letter received by Pamela Wible, MD. Dear Pamela: I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is ...

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Dont pay specialists for being on call. Heres why. Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER ...

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Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job.  It forever changed, and probably saved, my career. The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I ...

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It's a strange thing to be driving about in your car in the middle of the day.  For one who has spent the majority of his professional life sheltered in dark offices and aseptic hospitals, the summer sun and fresh breeze is quite lovely.  One almost begins to approach humanness.  Normal.  This must have been what it felt like before immersion into the tribe of medicine. Sometimes I have trouble remembering ...

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Shortening medical school: Is that a good idea? Why are we shortening medical degrees? The four-year medical degree has been the mainstay of U.S. medical schools for more than a century, following the publication of the Flexner report in 1910. Prior to this, there was little standardization about what a medical degree could or should look like. Medical school education was subsequently standardized to two years of academic study, followed ...

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A day in the life of a hospitalist I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more-senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second-career path, I have been planning my career in hospital medicine since the beginning of my residency training. The things that drew me to hospital ...

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Dr. Peterson, the radiation oncologist, gets right to the point. "The medical center's tumor board has concluded that your cancer is inoperable, incurable and untreatable," he says flatly. "Any chemotherapy or radiation treatments would be palliative in nature." He begins explaining the reasons behind the board's verdict, but everything he's saying washes out. My mind stopped working as soon as I heard the words "incurable" and "palliative." I am sliding into shock. Dr. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 1-day history of headache, left eye pain, nausea and vomiting, seeing halos around lights, and decreased visual acuity of the left eye. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Medications are metformin, digoxin, metoprolol, hydrochlorothiazide, and warfarin. On physical examination, temperature is 36.8 ...

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What is value in cancer care? It depends. Value. A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern. At the crux ...

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Hospital credentialing is one giant mess Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work ...

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I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long term care first from providers I ...

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Establishing a digital presence is rapidly becoming a necessity for health care professionals, medical practices, and institutions. Yet something that often gets obscured in the discussion is the fact that at its heart, digital media is about people. As such, it’s about relationships, and it’s about communication, and increasingly, your digital footprint means educating, engaging, and growing your audience. When you do this in a way that authentically reflects you and your ...

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I stared down at the tired, deteriorating woman sprawled across a bariatric bed before me. A breathing tube was in her throat while multiple catheters pierced her arms and neck, pouring powerful medications directly into her veins. Among several functions, these infusions would maintain her blood pressure high enough to keep her organs alive. This was my initial, visual impression of a patient I was responsible for during my first ...

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The flu vaccine is imperfect, but please get it anyways This year's flu vaccine, as you likely know, is taking a drubbing. The contention is that CDC flubbed, and didn't get quite the right flu strains in the mix. That is apparently true, although more the "fault" of the influenza virus and its natively wily ways, than of the CDC. Either way, the drubbing is disproportionate to any flubbing. The ...

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