Let me begin with by extending a hearty congratulation on matriculating to medical school. The pre-med years were tough with organic chemistry, staying involved with leadership activities, chasing down the elusive letter of recommendation, and sitting for the MCAT. But you did it. Be proud of what you've accomplished because you're one step closer to becoming a doctor. You may have fears, concerns or misgivings about what is coming your way and this ...

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Part of a series. Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples. AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to ...

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An interview with Jessie Gruman Jessie Gruman, who sadly died July 14, 2014, was someone I greatly admired as a person and as a patient activist. I interviewed her in late April for research I was conducting on patient activism, and she graciously allowed me to publish the interview, wanting, not surprisingly for those who knew her, to do everything she could to use ...

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Top stories in health and medicine, July 28, 2014From MedPage Today:

  1. Time to End Lethal Injection? The third botched execution of a death row inmate in a year should serve as proof enough that lethal injection won't work as an execution modality.
  2. HIV Cure Still Years Away. The African journalist asked a simple, clear, and direct question: When, people want ...

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One of the skilled nursing facilities I work with has a hospice unit.  We occasionally have patients on the hospice unit who might benefit from physical therapy.  The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient.  If the goals are ...

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As a family physician whose practice deals exclusively in the treatment of obesity, it strikes me as remarkable how little we understand about the disease, which is Canada’s second-leading cause of preventable death. In every region of the developed world, obesity doubled in the twenty years between 1988 and 2008, according to World Health Organization, which now count more than a half-billion of Earth’s population as obese. The Public Health Agency ...

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The house was getting cold.  My wife and kids snuggled in their blankets as I crept out of bed and checked the thermostat.  The subzero winter air howled as a blustery morning took shape outside our windows.   I looked at the digital display with disbelief and manually tapped the screen with my finger, hoping that the jarring motion would loosen the exact faulty screw leading to our frigid state. ...

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In medicine, the patient is not always right Beginning with the Institute of Medicine's (IOM) landmark Quality Chasm report in the late 1990s, the health policy establishment, the medical profession and the American public began to hear a new and disconcerting message: American health care was not patient-centered. The IOM prescribed a number of recommendations to redesign health care delivery, one calling for patients as the source of control over their care. "Patients should ...

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Many hospitals rely on bond funding for their expansion and the purchase of new equipment.  Revenue that is created by the hospital is then used to pay back the bondholders.  The risk to bondholders is that they are generally paid after the hospital pays its operational expenses.  Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk. Hospitals have historically been rated ...

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Today, I celebrated mental health care.  And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support. I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness.  The diverse stories of ...

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“Dr. Liu, I don’t think he has diverticulitis.” So said the second-year medical student. She had just completed her first year of anatomy, biochemistry, pathology, and introduction to doctoring at the local medical school. One of the sharpest medical students I’ve proctored. Like many summers, I’ve been fortunate to spend time with the next generation of doctors. These future doctors were brimmed with enthusiasm and energy.  Instead of taking time off to ...

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Should I be a nurse or a doctor? Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine.  Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless. But people ask me all the time, so as a little experiment, I ...

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Suicide Med: A medical school thrillerSuicide Med: A medical school thriller An excerpt from Suicide Med. “I wish I had become a ballet dancer instead.” I use the back of my forearm to swipe at strands of dark hair that have come loose from the tight bun at the back of my head. The attempt fails and the escaped locks fall back ...

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Luxury goods are items that people purchase in disproportionately greater amounts as their income increases. That’s how economists think of them anyway. But for the average American, a luxury good means something else. We tend to think of luxury goods being things like designer clothing, luxury cars, and high-end restaurants. Our minds fill with images of Gucci, Burberry, and Luis Vuitton, or Mercedes-Benz, Porsche, and Ferrari. One thing is clear to ...

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I recently read an interesting article in Glamour about why Zosia Mamet, an actress on HBO’s Girls, refuses to “lean in.”  While the column focuses on the influence of modern-day feminism on notions of professional success, her words resonated with me as a medical student and an aspiring psychiatrist.

“I have been incredibly blessed with success in my chosen career. I’ve worked my a** off and had the support and encouragement of ...

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Doctors still work while on vacation Last week, I took a 6-day vacation.  Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off.  While away with my family, I ran into people of different walks of life and noted ...

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I’m simultaneously a behavioral researcher, an ethicist, and a hopeless Facebook addict, so I’ve been thinking a lot about a recent controversial study in which researchers manipulated the emotional content of 689,003 Facebook users’ news feeds. In summary, users who saw fewer of their friends’ posts expressing negative emotions went on to express more positive and fewer negative emotions in their own posts, while users who saw fewer posts expressing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a "heaviness" involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and ...

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Since joining my current practice two years ago, I've noticed that I care for a disproportionate number of immigrants of Chinese and other Asian descent compared to my colleagues. Although both of my parents were born in Taiwan, I don't speak Mandarin or have special expertise on medical conditions common in Asian Americans. Nonetheless, Asian patients seem more comfortable with me anyway. Similarly, U.S. health workforce analyses show that underrepresented ...

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Sandeep Jauhar has this wonderful sentence in his New York Times op-ed, "Busy Doctors, Wasteful Spending": "There is no more wasteful entity in medicine than a rushed doctor." And yet physicians are rushed. Dr. Jauhar writes about the payment system driving shorter visits. That problem represents an important component of undesirably short visits, but it is not the only problem. The electronic health record adds documentation time, as do the billing ...

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