In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question. As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming ...

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The Business Insider article, "Senator Warns Fitbit is a Privacy Nightmare and Could be Tracking Your Movements,reports that Senator Chuck Schumer called for federal protections to prevent companies like Fitbit from collecting, sharing and selling consumer data to health insurers, employers and others. Fitbit, like Nike+FuelBand and Jawbone, sells wearable trackers that monitor sleep, health functions and physical activity. Senator Schumer accused FitBit and Smartphone apps of sharing users’ ...

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The Medicare trust fund has been extended to 2030, 4 years longer than projections made just one year ago. This sounds like wonderful news until you take a closer look. The fine print reveals that this is little more than campaign rhetoric. Four years in the grand scheme means little when you look at the real numbers. More baby boomers approach eligibility age every day. In 2012, there were 50.8 million ...

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Learning in medical school often feels like learning a completely new language. There are numerous acronyms (OPQRST, CAGE) and molecules (IL-1, TGF-beta) and more. But most striking to me are two particularly ubiquitous buzzwords: “high-yield” and “protected time.” I feel like I heard both these terms -- and particularly the former -- thrown around every single week of this past school year. High-yield has been used to refer to, as you ...

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I recently wrote about a hospital system in Colorado that had discovered a way to cross market its more profitable emergency room services if a patient first came to its urgent care center. Pretty clever! Then recently I came across another health care marketing trick close to home and just as sly. As I sat on a New York subway one sizzler of a day, an ad for an ice cream ...

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My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven't. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don't know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they ...

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

  1. I, Intern: Common Problems, Elusive Answers. Rebecca Karb, MD, crosses paths with patients in the Rhode Island Hospital emergency department who have ailments that she rarely saw as a medical student.
  2. Results Mixed With Home BP Monitoring. A hypertension self-management program reduced systolic blood pressure in high-risk patients, including ...

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It’s been a while since my last rant about electronic health records (EHRs), so let’s remedy that right now. EHRs in their current iteration are -- how to put this delicately? -- an unmitigated disaster. Nevertheless, much of the criticism of EHRs, including mine, has been in the destructive category. What about some constructive criticism? How could EHR software be made better? I am not ...

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In every life we have some trouble When you worry you make it double Don’t worry. Be happy. It will soon pass, whatever it is. Don’t worry. Be happy. – Bobby McFerrin Much has already been written in reaction to Robin Williams’ untimely death, about his incandescent talent, his prolific career, his decency and kindness, his addiction and his mental illness. His death robbed his fans of many more years of his genius ...

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The worst thing anyone ever said to me was, “You think you know everything, but let me tell you:  You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize ...

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He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "hellos," "good mornings," and "any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He hurried upstairs to the conference ...

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On the first day of school, a letter to my childs teacher I don’t know you and you don’t know me, but today you become one of the most important people in my life. You are the one. The one who I’ve entrusted to take care of my girl in my absence. The one who I’ve tasked with teaching her things that I cannot. The one who will make an indelible mark on her ...

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The epidemic of physician burnout is heartbreaking Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive. The burned-out physician is ...

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Top stories in health and medicine, August 27, 2014From MedPage Today:

  1. 'Sleep Drunkenness' Common, But Rarely Unexplained. So-called confusional arousals -- awakenings without coming fully aware -- were reported in the past year by some 15% of respondents in a population-based survey, with nearly all such episodes associated with mental disorders or drugs known to affect sleep.
  2. The Siren Call ...

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Oh yeah.  Hot dang.  All right.  Groovy. Boom goes the dynamite. I had a very great day yesterday. I saw three patients who had recent diagnoses of cancer.  Yeah, those two statements seem to contradict.  They don't.  Each person I saw gave me a clear view of how the practice I've been building over the past 18 months is making a difference.  A big, big difference. The first patient was a guy who is ...

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I’m all for free speech and I’m very hostile to censorship.  The response to ugly speech is not censorship, but is rebuttal speech.   Of course, there’s a lot of speech out there that should never be uttered.  Indecent and rude speech is constitutionally protected, but is usually a poor choice.    We have the right to make speech that is wrong. I relish my free speech in the office with patients.   I ...

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Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had ...

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It was July 2012 and I was pregnant with my third child. As an experienced mother and labor and delivery nurse, I felt very comfortable at 29-weeks gestation and anticipated the usual course of pregnancy. However, at 30 weeks, I started battling with preterm labor issues. This eventually led to the early delivery of my son, a four week and stay in the NICU, and a life lesson in cost-awareness ...

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A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic because someone has already accomplished them. My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes ...

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Solving the mid level dilemma: Call them what they really are Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: "Stop calling nurse practitioners mid-level providers." So do I, though my reasons are a bit different.  In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know ...

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