In "Big Med," his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing that the Cheescake Factory and other upscale restaurant chains successfully lower costs and improve quality by "studying what the best people are doing, ...

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I just finished the just profoundly awesome article "Why Women Still Can't Have It All" by Anne-Marie Slaughter, in this the Atlantic. This is the article that has all the buzz going about professional women and work/life balance. It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what ...

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The unspoken sentiment towards patients with advanced cancerI have been thinking about the cancer experience—what it must be like to be on the receiving end of a cancer diagnosis, to live with cancer, and to experience the treatments; to receive the news that treatment worked or that it didn’t. I also have been thinking about what it must be like to “carry” a diagnosis of cancer around. ...

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In order to be with my Dad, after dinner I'd go on house calls with him.  We'd drive to parts of town I'd never seen, and using the car's spotlight we'd search out the right house number, often with no small difficulty.  I'd usually wait in the car.  He hefted up his rather large mysterious black doctor's bag and headed for the door.  He spent about a half hour listening ...

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Only trained physicians should provide interventional pain services A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most ...

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How much should doctors reveal about themselves to patients? Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated.  In fact, some studies have demonstrated that doctors who talk about themselves more are rated more poorly by patients than those who are more private. This topic has been of interest to me and I have written about it in my blog:  Doctor, Patient, Friend:  Blurring the ...

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“The question” comes in several forms:   “Doc, what stage is my cancer?”  “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage.  “The question” superficially asks for a simple answer.  Time to live.  However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle. Years ago we ...

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There is a moment in everyone’s life, for oneself or a loved one, when one receives the “diagnosis.”  In that moment, eyes meet across the desk and the shell-shocked individual looks up and asks, “Doctor, what should I do?”  In that instant, the patient is putting all of their trust in another human being who is trying nothing less than to save a life. A good doctor has always been a ...

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Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all.  We want them to be chimeras of Drs. House and Welby. But, is this possible? I can't say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was ...

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I spent my first two years of medical school at the University of Utah frantically cramming for Step 1. My limited exposure to patients was restricted to shadowing only. My actual interactions with them were spotty at best.  Those first two years of medical school didn’t at all reflect what I would go on to love about primary care: building relationships with patients that would span many years. I now teach ...

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