In an article entitled Culture, Illness, and Care, medical anthropologist Arthur Kleinman writes about the important distinction between illness and disease.  He defines diseases as “abnormalities in the structure and function of body organs and systems.”  In other words, disease is what is actually physically wrong with the body.  In contrast, illness is what patients experience when they are sick.  This is profoundly influenced by multiple factors such as a person’s culture, social situation, and the ...

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A couple of weeks ago my nurse came to me with a request for a consultation.  Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in. She said, “I’m not sure about this one -- he says you treated him twenty years ago and he wants to see you.  But there is no new pathology so I don’t know how urgent it is.” I ...

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In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn't even the cheapest way to go to school...So the question is: why did we go? We went not because of the financial value of free--that is, zero tuition--but rather, because of the academic value of free. At Cooper Union ...

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"Do you mind telling your legions how long you intend to work?" Certainly. The short answer is, “Indefinitely.” The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts. First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my ...

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Consider this scenario. You are getting older, and are concerned about the costs of nursing homes and long term care.  So, you decide to get expensive long term care insurance to protect your family from these costs.  The policy will pay some of the cost of long term care if you develop cognitive or physical disability.  All you have to do is keep making payments on the policy until you have ...

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This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it. In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in ...

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When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.” Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop ...

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Hi.  This is doctor Rob, and you have reached my blog.  If you are here to read my blog, then continue to do so.  If this is an emergency, please call 911. That is one of my pet-peeves.  Every single doctor's office I call I am told the same thing: "If this is a true emergency, please hang up and dial 911."  I even got that message when I called the ER. When I ...

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In trying to understand my own burnout, "control" (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I'm unearthing bones not already thoroughly analyzed. But I can give instructive personal examples. For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During ...

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There’s a piece in the Atlantic entitled "The Psychology of Lululemon." I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out -- that in some way, clothes have power over the wearer. Of course, I ...

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