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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Like many of my colleagues in medical education, I am a part-time clinician.  My time is split, spending less than half in my own clinical practice with the rest devoted to resident education.  This is precisely why I love my job.  The diversity of each day keeps me engaged, challenged, and excited about the work I do. Unfortunately, this same thing that makes my job so fulfilling is often also a ...

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Physician burnout and physician suicide have been getting more attention in the last several years. Suicide among physicians is horribly tragic, and maybe moreso because of several factors. Suicide is the quintessentially most preventable fatal event. In order to prevent suicide, the person killing him or herself needs only not do it. To anyone who knows the victim/perpetrator, it seems that if only the right words had been spoken, the ...

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Hey ladies! And you gents too! Everyone is affected by breast cancer, either personally or by a family member or friend. Fortunately, we live in a time where breast cancer can be detected earlier and when detected, can be treated and cured. The key is early detection. There seems to be copious amount of information on the Internet: some good, some not so good. Let’s go through a few of these ...

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Medical care and understanding have changed since separation of physical and mental health made much sense. We know now that mental state and internal physiology influence one another and that social factors affect disease risk more powerfully than genetic ones. Still, as a health care system, we perpetuate a culture of division, and limit our capacity to help people because of our inability to categorize them neatly. There are so many with unmet mental health ...

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Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week -- eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your ...

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I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul ...

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I want to talk about the word everyone seems to use: drama.  This word is used in many facets, to describe conflict, negative interactions with others, disagreements, or obstruction to a new idea. No one likes drama. Yet some people seem to instigate it, and others seem to have to deal with it on a rotating basis. We all wish we could ignore it, avoid it, and leave it for people who ...

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Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital ...

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I have spent three days at the Society to Improve Diagnosis in Medicine. Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors: physician factors and system factors. We have a major system factor that can cause problems. Most hospitals in the U.S. require a diagnosis for admission. I ...

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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with ...

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“It is not for me to judge another man's life. I must judge, I must choose, I must spurn, purely for myself. For myself, alone.” -Hermann Hesse, "Siddhartha" What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But ...

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Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that ...

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Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days. “Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.” “Good to know. We may have to change the dressing more frequently.” “And this patient had constant ...

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“Jag ska bli doktor,” a four-year-old boy announced to his family sixty years ago. Somehow, everything he did after that moment seemed to move him in that direction, even when, on the surface, his path through life seemed to be meandering. As a student, he was just as interested in literature and philosophy as he was in scientific subjects. He even failed his first quiz in organic chemistry just after receiving the ...

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Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine. Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment ...

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“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical ...

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An excerpt from Cancer What You Need to Know. Treating cancer means taking care of the whole patient -- the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond. Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, ...

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