"I'm going to the doctor next week for my yearly physical." So normal. Of course you are. Everyone should do that. But the concept of a yearly examination of one's whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question. I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at ...

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Let me preface this blog by stating that I write this to stimulate discussion and debate, not to sway opinions. Today, doctors are required to spend more and more time doing administrative work -- including checking off electronic boxes in the electronic medical record (EMR) -- the result is less quality time with patients. Now, those that are in Washington, DC think that requiring physicians to ask about guns in the home ...

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Even the most honest among us do not tell the truth all of the time.  We are flawed human beings.  We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal?   Have you ever "borrowed" someone else’s idea and represented it as your own? A few weeks before I penned this, I was presented with two opportunities to lie in order to save a ...

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Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce. The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really -- if you had it). This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for ...

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Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” ...

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“Please don’t cut off my pants,” he pleaded. “I am homeless, and they are my only pants. Please.” He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life-threatening injuries as a level 1 trauma activation. Based on the location of ...

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My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within. Often, when what a patient is saying doesn’t make sense, or it is ...

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To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers. Case 1: Downgrading caviar to boiled salmon A patient was referred for a CT angiogram run ...

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I can't believe I'm writing something with this title. Anyone who knows me and sees my name next to that title will probably spit their coffee all over the kitchen counter. And to all the people who have dealt with me on call, let me begin by saying, I'm truly sorry for anything I might have said, done, thrown or broken. Mostly. Kinda mostly. Those who know me will likely think ...

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Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them.  Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are ...

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