It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this? In 1847 the AMA published its first "code of medical ethics" which covered many subjects and, though short, is dense and diatribe-like. It seemed to ...

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Doctors don't like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a ...

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Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad. I’d be interested to know how customer satisfaction played out in my home. "Kids, now you’ve had a week of school-work. Please fill out the attached survey ...

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After 18 years in private practice, many good, some not, I am making a very big change.  I am leaving my practice. No, this isn’t my ironic way of saying that I am going to change the way I see my practice; I am really quitting my job.  The stresses and pressures of our current health care system become heavier, and heavier, making it increasingly difficult to practice medicine in a way ...

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All parents have heard their kids complain that but for 1 or 2 percentage points, they would have achieved a higher grade. “This is so unfair! My average is 89.9999 and he is still giving me a B+!” Every kid should receive an A, of course, since psychologists are now professing that every kid is a prodigy in some new measure of intelligence. Academic intelligence, the conventional and obsolescent notion, has been ...

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Atul Gawande, MD is a brilliant writer, no-doubt an excellent surgeon, and many would say a physician-visionary for all that ails America’s health care system.  He speaks first-hand of the changes that have occurred in American health care and recently offered his perspective for fixing our health care system to the fertile minds of Harvard’s recent graduating class of 2011. In his graduation speech, published front and center (yet again) ...

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My husband and I had a family practice in Arcata, California, for 28 years, during which time we learned the importance of addressing the patient’s context outside of the medical visit in order to maximize health and self-efficacy. We went to great lengths to keep patients out of the ER and hospital.  I saw one patient with massive pedal edema twice weekly for months to wrap her legs, since she lived ...

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The Pap smear, in which a clinician gently scrapes and brushes cells from a woman's cervix (the lower portion of her uterus or womb), swishes them in a bottle of fixative solution, and then sends them to the lab to determine if the cells show pre-cancerous or cancerous changes caused by the sexually transmitted human papilloma virus (HPV), is a pretty simple procedure that takes less than a minute to ...

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Faith.  A simple word with complicated meaning.  It is a seed buried deep within our spiritual cores, ready to be nourished and blossom with the sprinklings of tragedy.  It is a belief that things will work out, despite our lack of vision for fate's secretive reasons of the bumpy journey we must endure.  It is an inherent hope that has either sustained us or has failed us miserably.  Yes, to ...

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With all of its frustrations and challenges, I love my job.  In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine. When I was in grade school, I wanted to be a physician.  My parents would take me to the pediatrician for routine check-ups or when I wasn't feeling so great and I remember ...

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