One tired early morning, during my residency, I had been up all night in the ICU with a sick patient.  Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn't leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: "The sign of a good doctor is when you can't go to sleep at night worrying about ...

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Next in a continuing series. Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there's music playing, that's what I do when I operate. And for reasons about which I have absolutely no clue, I nearly always "whistle" The Caisson Song. I've always wondered if anyone ...

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The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex.  Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped.  Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling.  The lung cancer has spread, metastasized.  Really bad news. A ...

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I'm not big on spying on teens generally. I think that privacy is important. And by the time they are teens, in most cases we need to trust that at least some of the stuff we've said for years has stuck--and we need to let them learn to be independent and make choices without us. That said, if you have a teen who drives, there's some spying I suggest, assuming you ...

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The Wall Street Journal has a question that I cannot really answer in their article, Nurse Practitioners and Primary Care. This question has an implicit assumption that primary care is one thing, and that that thing is relatively straightforward and simple. I have written about this problem incessantly for the past 11 years on this blog. The term primary care has become the equivalent of a Rorshach test. When we ...

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AP8702110449-jpg_230144 I have been thinking a lot about C. Everett Koop lately, ever since his death on February 25 at the ripe old age of 96 and more recently with the announcement that our current Surgeon General, Regina Benjamin, is planning to step down from that post. In particular, I have been pondering what made Koop such an effective Surgeon General, and what ...

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I knew from last night's house call that my patient Bessie's time was near. All day long I'd felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn't surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail. It was Bessie's daughter, Susan. "Mom is gone," she ...

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Hi. I’m Rob and I am a recovering doctor.  Yeah, I am recovering ... doing a lot better, actually.  Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.  I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better.  I ...

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It was just like every other email I had gotten in the past.  A young student at a local university was interested in primary care, and wanted to shadow me for a month between his second and third years.  I responded swiftly.  I was delighted to bolster the interest in my specialty.  Over the years I had helped train students, residents, nurses, and nurse practitioners.  By exposing them to the office, hospital, nursing ...

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The biggest mistake patients make isn’t what you think. It isn’t turning down tests or treatments their doctors recommend. Nor is it deciding not to take the medicines their doctors prescribe. It isn’t insisting on getting a test or beginning a treatment their doctors recommend against, either, and it isn’t failing to exercise, stay out of the sun (or use sunscreen), quit smoking, or lose weight. No, the biggest mistake ...

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