Loss is something all humans face in their everyday lives.  As a physician, the effects are often magnified.  People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere.  Parting can sometimes bring relief, and others a deep sense of failure.  But with Clara, I'm not sure we actually parted.  Mostly, I was left with confusion. Clara came to me by way of the nursing home.  ...

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I awoke one Saturday morning to a terribly familiar feeling -- a tight, barky cough, fast breathing, severe shortness of breath and burning in my chest. Another severe asthma attack. I knew I was in trouble. Twenty-three years ago, when I was an internal medicine resident, I went to be evaluated for recurrent pneumonia. I wound up being diagnosed with cough variant asthma. Most asthmatic patients wheeze; when my asthma is ...

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Abuse-Schedule-476x640 A physician in Texas posts this photo on Facebook. Caption: “My schedule one morning in January 2014. Never again ...” Yay! Another physician breaks free from assembly-line medicine. High-overhead, high-volume offices sacrifice the sacred physicians-patient relationship and perpetuate a disease-billing management system. This is not health care. It’s abuse. Patients: Avoid clinics with 10-minute slots. Go for docs who offer 30 to 60-minute appointments. Physicians: ...

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I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues. We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor. It has taken us a long time to get here. Let’s do some math. 4 years of college + 4 years of ...

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Recently I wrote about the problems with maintenance of certification requirements.  One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other ...

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Assigning patients to doctors. Who still does this? We don’t assign hungry people to restaurants, hairy people to barbers, or passengers to airlines. Even State Farm allows me to choose between Maaco or my local chop shop every time I crash my car. We do assign kids to teachers, but still, I don’t need too many analogies to tell me that assigning patients to doctors is a bad idea! The average U.S. ...

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Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

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Help, I need somebody! Help, not just anybody! Help, you know I need someone, help! - The Beatles We are all here on earth to help each other; what on earth the others are here for I don’t know.  - W. H. Auden “Help the doctor!” I’m sure most surgeons have heard this exasperated statement at some point in the operating room. It is said with that special mix of frustration, irritation, and sarcasm, usually when things aren’t going ...

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Early on in my career I called an Indian internist in the middle of the night to admit a patient to him. The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.” I can still recall our 4 a.m. conversation: “Hi, Dr. ...

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Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free. But when I started my first job as an attending physician in central Massachusetts, I was in for a big shock. I had ...

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