I visited Safdarjung Hospital in New Delhi recently – an institution with  1,531 beds and 145% occupancy rate.  Yes, 145%.  You do the math.  A lot of bed sharing and asking families to bring in cots.  It’s right across the street from the All India Institute of Medical Sciences (AIIMS), the premier public healthcare institution in India.  While both AIIMS and Safdarjung are run by the federal government, ...

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I expect most of us agree that an incarcerated felon experiencing a heart attack should receive medical treatment, even if that treatment comes at taxpayers’ expense.  The same probably goes for more preventive measures—blood pressure pills, cancer screening tests and the like.  While serving out the sentence for their crimes, prisoners should not be forced to suffer from treatable and preventable illnesses without receiving appropriate medical care.  They can pay ...

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Physician a burnout has great current interest.  Many authors are worrying about burnout and therefore writing about this problem. What are the common root causes of burnout?  Primarily burnout comes from loss of control and overwhelming undesirable activities. Burnout occurs when the job becomes overwhelming. Burnout likely is increasing because many physicians feel that they do not control their lives.  Too often the current finances of medicine "force" physicians to spend inadequate time ...

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I recently treated two young men, both injured in the same football game.  On the way out, one passed the other in the hall, injuries treated and dressed. "See you next game!" they said.  They laughed and looked forward to the struggle. My wife and I have tried to raise our kids that way.  To enjoy life, to move through difficulty and injury. They suffer from having a physician father, so ...

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In June of 2006 Mary Ann Ambrogio went to see her gastroenterologist Dr. Frank Troncale in Connecticut for a follow up of her history of liver cirrhosis and associated hepatic encephalopathy. Reportedly following this visit Mrs. Ambrogio was driving home when she passed out and hit a pedestrian John Jarmie causing “severe and permanent” injuries. The injured pedestrian sued Dr. Troncale claiming malpractice under Connecticut law in that the ...

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During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don't have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much ...

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I wake up at 4am feeling nauseous. I'm not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, "Wow." Then they vomit again. And then a third time. And now it's on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, ...

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I recently took call on the pediatric ward. Our team was caring for a young patient facing a new diagnosis of a chronic illness. In addition to stabilizing her symptoms, coordinating care with her new specialist, and managing her medications, I also see it as our job to make sure she and her family start to understand what is going on and what this diagnosis means for her. How does this ...

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Not all cancer survivors have cancer“You look amazing!” It was the first thing out of my mouth upon seeing Sharon.* She is a woman in her mid-seventies, and she has recurrent ovarian cancer. We had met after she was diagnosed with recurrence, only five months after the end of her “curative” treatment. At the time, we talked about her life—how she had been a nurse before ...

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Hi! My name is Ima Frawde and I am so glad that you have chosen me to be your guide during your climb of Everest. The fact that you have chosen me indicates that you are well on your way to mastering the most important skill in climbing the mountain: Trust Everest. And why shouldn’t you trust Everest? The mountain is totally natural; climbing is totally natural; reduced oxygen concentration at higher ...

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