I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200,000 a year when the median household income is in the mid-$40,000 range. What this article is ...

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Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2 a.m. at an emergency room to find a "closed" sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that ...

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I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs. I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in ...

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When was the last time you used heroin?  In the past have you injected heroin or any other drugs?  Are you currently using drugs besides opiates like methamphetamines, cocaine, benzodiazepines or alcohol? After two years of family medicine residency, I ask these questions like they are questions that everyone asks in a casual conversation with a patient.  Although these types of interviews are customary for me, I recognize that it takes ...

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asco-logo I was at a meeting in 2014, called the REV Forum; its objective was to rethink cancer care delivery by gathering patients, advocates, thought leaders, and entrepreneurs. Even now I am struck by some of the things I learned that day. One that stays in mind is when a woman who looked like she was in her ...

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For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors ...

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The practice of medicine has changed dramatically over the last couple of decades, with many of the changes unfortunately not so good for patients. It’s a well-known feeling among health care professionals, that among all the new elements of bureaucracy and information technology requirements and mandates, the one person who is often completely forgotten about is the patient. As someone who has worked up and down the east coast in ...

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ZDoggMD nails it again.  See what Doc Vader thinks about patient satisfaction.

Heart of summer. Early August. All of Holland is on holiday. We are sitting in the flesh-colored morning light, in his back room, stuffed away behind the nurses’ station. He is sick as hell and just 32. I am sitting next to his mother and his girlfriend. The intern and nurse are standing behind me, breathing carefully. He sits with his back to us, at his table. Visibly fighting for air. ...

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I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around. When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify ...

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Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there? I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to ...

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Despite the opinions expressed in column, "Here’s why you can’t believe 'top hospitals' lists," Harlem Hospital richly deserved the 2015 Top Hospital distinction it earned from our nonprofit, The Leapfrog Group. Our Top Hospitals committee sets the bar high, selecting only hospitals that perform at or above the level we would want for ourselves and our families. We used data from the annual Leapfrog Hospital Survey, calculating which ...

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It’s only been a week since we lost you, and I already miss you so very much. There are days when I feel like I’m OK, but there are nights I cry myself to sleep thinking of what life could have been for my second son or daughter. Miscarriage: Losing a baby before reaching full term can be as devastating as losing a child at any age. My first experience with ...

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I am going to confess that I am my children’s pediatrician.  I have given them every vaccination they have ever had and probably would not trust another provider to do it.   I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease.  I completed medical school and three years of pediatric training that helped shape this belief.  I have seen death ...

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Five months in the NICU made the daily 20-mile drive to see our son at Swedish Medical Center in Seattle quite tiresome. He was born prematurely at 22 weeks and 6 days of gestation, and we felt uprooted, wondering if we would ever get him home.  Then we met some Alaskans in the waiting room, who told us stories about being hustled on to air ambulances when pre-term labor was ...

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Medicine has a fraught relationship with money. Dealing as they do with matters of life and death, doctors are loath to assign a dollar value to human life, preferring to avoid the subject altogether and instead provide the care that they deem appropriate no matter the cost. Insurance companies, on the other hand, make their business in rationing health dollars and have no such qualms: the consensus among them is ...

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Yesterday I caught myself doing something I had told myself I would never do, especially not in residency. I heard the medical student present the patient as a, “35-year-old male with a past medical history of poly substance abuse, noncompliance, and multiple stints in rehab,” and I caught myself rolling my eyes and writing drug seeker in my notes on the patient. This was not my last day practicing medicine ...

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When you enter medical school, you have this very esteemed white coat ceremony.  It's a memorable occasion, where speakers tell newbie medical students and their families all that it means to wear such a coat: the responsibility, the ethical code, the professionalism, the compassion all intertwined to make up the very fabric of each emblemed cape. My coat was part of my dilemma.  It wasn't that I couldn't be all the ...

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The cancer moonshot initiative raised skepticism because of the limited funding to end cancer. Unfortunately the recently announced panel membership confirms that while the project may launch, skewed representation may tilt the mission off course. It is no surprise that the panel heavily tilts toward immunology, medical oncology, surgery and big science. But three core specialties you would find at any tumor board are missing: pathology, radiology, and radiation ...

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