“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.” “If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.” “I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.” I hate to be manipulated. Hate. It. There is a certain ...

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A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society.  One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years.  This is more along the ...

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In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor's appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often dozens of patients call for a limited number of appointments. ...

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My shift is over and I’m ready to head out the emergency department door.  When I walked in 12 hours ago, the department had 20 waiting patients.  I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds.  My partner Dr. Jim looks at me and says, “Get ...

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Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to? At the moment, there is very little information for you to make such a decision. Many people will choose ...

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The American Congress of Obstetricians and Gynecologists (ACOG) issued a recently regarding legislative interference and health care decisions. Specifically, the release states that: "Government should not interfere with the patient-physician relationship without a substantial public health justification." The full Statement of Policy was approved by ACOG’s Executive Board. Some recent examples of government interference include mandatory age requirements for Plan B, transvaginal ultrasounds before abortion, prohibiting doctors from asking ...

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Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer ...

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Vermont became the first state to enact a law authorizing physician-assisted suicide through the legislative process.  As the governor signed the bill, Jean Mallary watched carefully over his shoulder. She’s the widow of the late Dick Mallary, a former speaker of the House and U.S. Congressman.  Mallary was in pain and suffered from terminal cancer when he chose to end his life over a year ago. Jean Mallary’s story ...

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It was my second day of residency, and something was afoot. As I made my way around my first rotation on the cardiac floor, my medical senses were tingling. There was something strange happening to all of my patients, I saw. As I peaked over my cohort’s shoulders, I secretly saw that it was happening to their patients too, though they hadn’t seemed to notice. Only I did, and I was ...

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The sudden illness of a colleague is always a shocking surprise.  As physicians, we are trained from an early age to ignore our own infirmities in the service of others.  Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for ...

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