It's Friday afternoon and I check the day's schedule. A name jumps out at me and I groan a little and worry -- what am I going to say to someone I've treated for twenty years, who's my age and just been admitted to hospice care? If this is goodbye, how do I as a physician, who is more than an acquaintance but not quite a friend, handle this appointment? All ...

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LanceArmstrongOprahinterview “Lance Armstrong is a bad guy who has done some very good things.” These are the words of a sports radio personality I listened to yesterday.  He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs.  The sportscaster, along with many I heard talk on the subject, were not as upset by the ...

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The health care scene is evolving. Rapidly. We all know that. Thanks to legislation, changing patient expectations and physician shortages, we are all in for a roller coaster of changes over the next few years. But what does this mean for physicians? Plenty. Most importantly, it means physician’s roles in the health care system will change. Drastically. And that means the traits and skills you’ll need to be successful will change, too. Some traits ...

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shutterstock_68491828 The patient – blue-eyed, red-haired, and healthy but worried looking – guided the doctor’s hand to just below the angle of her jaw, where a small lump was barely palpable.  She had first noticed the swollen lymph node after a cold and thought nothing of it at the time.  But five months later, it was still there.  She knew it was nothing, ...

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For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother.  She called while I was at the mall with my family doing some last minute shopping—I ...

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As a pediatrician at a busy county clinic with close proximity to pediatric specialists, I care for a significant number of children with special health care needs. Instead of colds and ear infections (though there are those too), my days are often filled thinking about gastrostomy tubes, tracheostomies, and ventriculo-peritoneal shunts. I sign orders for specialty formulas and nebulizer machines. Many of my patients have thick charts and diagnoses like ...

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A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch. And I agree. Comparing guns and cars is fair, after all they kill about ...

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Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here. First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies ...

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Don’t be surprised if patients start asking more questions than usual about awareness under anesthesia.  We can all thank a recent article in The Atlantic magazine, with a large-print headline on the cover:  “Awake Under the Knife”.  Written by a UCSF medical student in preclinical training, the article not only assures everyone that awareness can happen, but takes pains to point out that anesthesiologists can’t always prevent it. The ...

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It’s showtime.  No need to worry.  This is just another routine performance.  I can do this.  All I need to do is get on stage, do my dance, and wait for the curtain to fall.  Then move on to the next stage and do it all again. The curtain opens. My patient is wheeled into the operating room.  With the help of the circulating nurse, we guide her from the hospital gurney ...

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