I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good. I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came ...

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I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling ...

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This is an interesting dilemma, but honestly, I could use your help. A former neighbor (not a close friend, but a pleasant fellow whom I run into less than occasionally) rented a house to a medical student and his family. They seemed reliable enough, and signed a 4 year lease. Over time, the medical student and the landlord began to feud over who does what. Usually things like landscaping were at ...

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Two recent articles highlight the challenges we will face as our healthcare system changes with regard to how care is delivered and reimbursed. The first article from the New York TimesMedicare Panel Urges Cuts to Hospital Payments for Services Doctors Offer for Less, notes that large hospital-centric systems of care do not necessarily serve patients well in terms of cost and sustainability. The second on the front page of ...

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shutterstock_125691797 What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of "it doesn’t really matter, as long as they are competent and do a good job.“ Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in ...

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asco-logoRecently, my family experienced the loss of someone very dear- Uncle Peter. Peter was an ex-Marine, father of three men, and patriarch of my spouse’s family; not to mention, husband to my wonderful and artistic Aunt Helene. He had been admitted to an outside hospital with leg ischemia and was transferred to a tertiary facility. Unfortunately, things did not turn out ...

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"Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.” This was a comment on one of my blog posts. Well, we have been talking about the way psychiatric patients get to the ED and ...

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“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.” It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit ...

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More people are dying because they commit suicide than in motor vehicle accidents this year.  The number of suicides is rapidly approaching the number of deaths from breast cancer.  The trend upward has been noted for the past decade. Physicians are the professional group with the highest rate of suicide. And studies have estimated that women physicians have as much as an eight fold rate of suicide compared to their male colleagues.  ...

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I was a very shy child. I never felt comfortable speaking up, especially in groups or in new situations. When asked a question in class, my heart raced, my eyes teared up, and I felt sweaty. As I grew up, these physical reactions subsided as I learned to internalize and manage this fear. But at that time, I could not have imagined that my professional career would depend upon my ...

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