So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing. In this country, we traditionally eat three meals each day.  Why not four or two? We prefer soft drinks to be served iced cold.  I’ve never tried a steaming hot Coke.  Maybe this would be a ...

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Dont be stupid, and other wise words to new college students Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me me give you some wisdom. First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for ...

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I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless: “Modern medicine had to start somewhere.” On the third episode, last Friday ...

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What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

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Dissent and cynicism: Learning from listening to doctorsDissent and cynicism: Learning from listening to doctors An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care I just listened. They were very unhappy and angry. I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that ...

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What every college freshmen ought to know about sexual assault Dear college freshman, I just saw you in clinic a few weeks ago; your last check up before college. We talked about a lot of stuff, updated shots, filled out forms, hugged good-bye; crammed in what we could in just a few minutes. It was a great to see you. Now that you are out of the office, away from the distractions of a buzzing ...

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MedPage Today recently tackled a very controversial issue in medical practice.  The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures.  As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice. According to the 
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My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

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Part of a series. Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.”  Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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