It seems that in the past few weeks, physicians across America have reached the breaking point. Internist Daniela Drake wrote in the Daily Beast about how miserable it is to be a physician. She talked about the lack of respect, the lack of time to see patients due to increasing paperwork and the ever-present board certification processes. Orthopedic surgeon Daniel Craviotto Jr. wrote "A Doctor’s Declaration of Independence" in the ...

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Remember personal responsibility? There actually was an era of responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes. I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault. In today’s culture, this is not scapegoating, but the pursuit of justice. Welcome to the era of big victim. In the ...

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I was working overnight in Tiny Memorial Hospital, located in scenic rural America.  My call room there was a converted patient room.  As such, my bed was a hospital bed.  Lying there one night, I rolled to the side and raised the head of the bed using the button on the rail.  The blanket was standard hospital fare: stiff and thin.  And the television remote, fully two pounds and connected ...

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A well-to-do patient recently boasted to me about an expensive insurance plan that he had purchased to “guarantee” that he had access to the best health care in the United States. Coverage included access to elite academic centers (all the usual suspects) and a private jet service for emergencies. He was utterly confident that his investment was worth the price, but I withheld my own misgivings. Hospital quality data suggest that ...

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“Doctor, can I record this conversation?” It’s happened to me a couple of times already. But the question above was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smartphones have made it all too easy for patients to secretly record conversations with their health care providers. Simply hit a button,  lay it innocently down by your side in ...

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His wife thinks he looks like Tom Cruise.  There is a resemblance, I can see him riding a motorcycle off the side of a burning building, jaw fixed, eyes on fire, ready to save the damsel ... only he is not so short.  Funny, brilliant and genuine, we have known each other for exactly two decades, sharing the growth of our families, the anxieties of middle age, and the vicissitudes ...

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When someone asks me about what it is like to be a doctor, a funny thing happens.  My eyes start to water and the words catch. It's rather comical how emotional I can be.  I have been all my life.  I sometimes feel the sadness flow through me.  I am a sieve.  Whether it be a touching book or a sappy TV commercial, I cry.  Silently.  Often missed by others in ...

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About 25km outside of Sao Paulo, Brasil, in a small city called Barueri, lies the grave of my mother’s cousin. Henrique was the Brasilian version of Mr. T -- a larger than life character, he spent his days on the pitch as the starting goalie of a local football club. “Senhor Henrique” was well known.  He had three major trademarks:

  1. His favorite words to opposing players were “tenho pena de tolo” ...

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In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park. Only ten minutes earlier, when we first met, Mr. A had been weary, his face drawn, and his speech so quiet that the sound of the aortic balloon pump keeping him alive made it nearly impossible to ...

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People lie. Patients lie.  Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear. A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on.  Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all. Providing primary care to patients on the furthest margins of ...

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