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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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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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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Despite convincing results for many health care interventions, translating evidence from research into clinical practice is often challenging. Implementation barriers are myriad and complex, but a number may arise from core design issues. While real-world environments are clearly vital to the success of any intervention, many traditional research efforts are structured to remove them from the proverbial equation. In studying the impact of a new medication, for instance, a group might ...

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Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of "more deserving" U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has ...

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asco-logo “Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert." – Sir William Osler, “The Father of Modern Medicine” (1849–1919) In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when ...

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How do you learn to be a good doctor? Sure, you study anatomy, and make flashcards, and memorize nerve pathways, but what makes someone a good doctor is the way they apply all that knowledge to real patients with compassion and diagnostic expertise. Strong “doctoring” skills, like listening carefully, taking a comprehensive history, explaining medication and treatment options clearly and patiently, and writing notes that colleagues can understand, are what ...

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His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me.  Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.” The thirty-something C-something-O was blown away by what I did for work.  By this time a small crowd had gathered, standing in ...

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Fidgeting in my seat, I waited nervously in one of the most crowded waiting rooms I had ever been in. Suddenly, I felt like a bucket of ice water had been dumped down my back; my legal name was being called over the dozens of waiting room sniffles. My instinct was to remain glued to my seat, not to let anyone know that I was the person attached to that ...

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The family medicine fellow set down her pen and inhaled deeply. “So when is it OK to cry with a patient?” she asked the senior attending across the table, a veteran internist in her mid-60s. About a dozen of us -- fellows, physicians, writers -- sat hunched over a paper- and laptop-strewn table in the fellows’ shared office, talking about a poem: Sharon Olds’ “Death of Marilyn Monroe.” In it, Olds ...

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