Once an alcoholic, always an alcoholic. This is one of the main tenets of Alcoholics Anonymous, and it serves to encourage its members to commit to absolute abstinence. It is also a belief, I have come to realize, held by the many medical residents I have encountered. When an alcoholic patient is admitted to the hospital, it is no secret that he (or she) is an alcoholic. This is because it feels ...

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shutterstock_230620183 Every year 300 to 400 physicians commit suicide. More than 10 percent of doctors are thought to have depression, a frequent precursor to suicide. Rates of depression and suicide among physicians are higher than in the general population. Many reasons including stress, heavy workload, sleep deprivation, lack of autonomy, and lack of outlets for personal care may contribute to higher vulnerability in doctors. ...

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To most physicians my illness is a routine incident in their rounds, while for me it's the crisis of my life.  I would feel better if I had a doctor who at least perceived this incongruity.  - Anatole Broyard For medical students to treat illnesses of all kinds, we must first fill our brains with thousands of facts, everything from anatomy, to physiology, to microbiology, and biochemistry. We essentially become robots, pounding ...

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shutterstock_203129515 I am sorry that you are in the hospital. You are feeling ill. The noises are loud, people are walking in and out of rooms, and you aren’t sure of what to expect.  You are probably nervous.  This whole situation is a disturbance to your life. You would rather be at home -- I can understand that. Few people want to ...

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Physician burnout has been previously described as heartbreaking, and this may be an understatement.  The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days. Unfortunately, these topics are still not formally taught in American medical schools. As students, we really do not know ...

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The non-medical reader may wonder what I am complaining about.  Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade.  But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order ...

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I was glad she never asked if I had done this before. My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for ...

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shutterstock_169002578 Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam.  Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test.  Wow, she must be the most awesome, most well-read, most skilled, most ...

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Amid the many ongoing changes to health care, it's clear that better teamwork is needed in American medicine. Calls for stronger interdisciplinary collaboration have permeated position statements and policies, and organizations have begun redesigning care processes to include novel team-based approaches. Emerging data continue to affirm that strong teamwork and communication can increase the value of care. Of the many efforts to improve teamwork, however, one potential area for significant improvement ...

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At the outset of this process of becoming a doctor, a friend and mentor of mine, a professor emeritus of medicine known as a mentor who cares deeply about his students and for his New England style dinner parties, sat me down to explain the gist of medical school. The first two years, he explained -- bowtie notwithstanding -- are the equivalent of studying a language from textbooks. You must first ...

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