As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur ...

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One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances. My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target. On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for ...

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At the end of life, never underestimate the power of a map When you set out on an unfamiliar journey, you will need a map to get to your desired destination. You may pass landmarks, but not know exactly where you are unless you are able to identify these landmarks on your map. The same is true for the journey of life, and specifically, the path at the end of life. You may know ...

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3 clear signs that you work in a hospital You try to hide it. You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party. But regardless how much effort you put into leaving your career where it belongs, it is so obvious that you work in a hospital. And here are ...

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Improve your work life balance: A schedule hack for doctors In this article I will show you a push button shortcut you can use to quickly create more work-life balance, no matter how busy your practice and your life feels at the moment. When it comes to creating balance between your medical career and your life, there is a simple rule in play. The strongest structure wins. When we are talking about ...

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What doctors can learn from working at Starbucks She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly ...

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Dear Patient(s), Thank you for educating me. Thank you for letting me shine bright lights into your eyes and place Q-tips up your nose. Thank you for not shooting me a dirty look when I ask you to lift up your pendulous breast so I can listen to your heart. Thank you for letting me ogle at your protuberant belly—whether it contains a baby, a liver tumor, or liters of fluid inside. ...

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Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, "Hey, Doc, who you gonna vote for?" He had an Obama T-shirt by his bedside. Chuckling politely, I asked him why he wanted to know. "I'm curious, Doc," he said. "It tells me your worldview." He said that if we agreed on who should be the next president, ...

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The folly of breasts and politics This blog is about freedom and personal responsibility.  I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties.  I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the ...

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Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Would you expect the Center for Disease Control to get involved in trying to figure out why these people died and how to prevent ...

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