Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?” The bad Patients, left ...

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It turns out that when Shakespeare asked, "What's in a name?" he didn't have medical providers in mind. In the last decade, the nondescript and confusing term "provider" has crept into the American medical lexicon thanks to the Centers for Medicare & Medicaid Services (CMS) which defined a provider as a Medicare participant that is contractually obligated to provide health care to Medicare beneficiaries. This was beginning of clubbing all ...

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The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there's free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We're prepared to handle them. "Where is the patient?" I inquired. "On the way down from ICU. The surgeon's on his way in," I was told. Hmm … ...

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Recently, the Joint Commission issued a statement written by its executive VP for healthcare quality evaluation Dr. David W. Baker, explaining why it was not to blame for the opioid epidemic. If you haven’t already read it, you should. Here is the first paragraph of that document: “In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, The Joint Commission’s pain standards take that ...

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Once a month, she waits patiently in my exam room, despite the fact that I’m almost always running an hour late in my hectic community health center practice. She is 86 and suffers from mild dementia, diabetes, arthritis and an arrhythmia for which she takes warfarin, a powerful blood thinner. At every visit, she comes to me with some sort of homemade gift -- a scarf, a tin of cookies, ...

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“There are three kinds of lies: lies, damned lies, and statistics.” There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical ...

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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

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The patient arrived in the pediatric intensive care unit one summer early in my medical training. The weather was still warm, although the unforgiving heat from earlier in the season had mercifully passed. The whole thing had been an accident: The child, a toddler, had been left in the car outside her father’s office, discovered several hours later when the father returned to retrieve a document from the back seat. ...

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This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place. The other day, a family mentioned having their “rainbow baby” referring to a child born after a tragedy.  To me, rainbows symbolize that even after the roughest storm, things can get better.  To see a rainbow, there must be moisture, like falling rain, in ...

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If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist, I would have thought he had lost his mind.  As the career medical director of community-based cancer centers, I was used to running the show.  And as the saying goes, I ran a “tight ship.”  Consultations were performed and documented in a timely fashion, day of the request if the ...

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