There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand ...

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“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.” These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her ...

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In psychology, the Lake Wobegon effect refers to a mythical town where “all the women are strong, all the men are good-looking, and all the children are above average.” In other words, humans have a tendency to overestimate their capabilities, particularly in relation to others. As a physician, I have yet to meet a fellow doc who didn’t think that their patients loved them or that they weren’t great clinicians. And ...

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One thing I learned early on as a doctor is different people have different tolerances for pain.  At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot.  She arrived wailing in pain, and we had to take her back to a treatment room ahead of other patients because her howling was scaring the people in ...

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When getting a medical history, patient attribution can be very helpful.  We are even taught in medical school to specifically ask patients what they attribute their symptoms to.  For example: Doctor: “What do you think is causing this pain in the right upper part of your abdomen?” Patient: “It happens every time I eat a big meal, especially a fatty meal.  I think it has to do with that.” Doctor: “This pain might ...

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From her vantage point, cost had nothing to do with money. On most days, she struggled to her feet when I entered the room, greeted me effusively, and escorted me to her bedside chair, all the while chattering about the inadequacy of our hospital’s slushies, the beauty of the day outside, and the latest update on her children’s accomplishments at school. Despite her debilitating malignant small bowel obstruction from ovarian ...

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I’m not racist. I would never refuse to give a patient pain medication or fail to properly get her on a transplant waiting list just because she was black. And, yet, to deny that I hold any bias would be foolish, naïve at best. Ask any American if he or she is racist, and you’re likely to get a resounding no. Look at numbers on interview callbacks or prison sentences, and you get ...

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I’m not going to be a doctor. It feels more like a confession than a statement -- like I’m disappointing someone. Each time I say, or even think, those words, I feel as if I need to atone for it. Survey a hundred scribes.  Ask them of their goal in becoming a scribe, and all of them will tell you about higher aspirations. They want to be surgeons, cardiologists, intensivists, ...

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I walked silently into the pristinely decorated room of the hospice facility and was greeted by her family.  She lay there, not particularly responsive to her surroundings under the pressure and influences of metastatic stomach cancer.  The warmness and smiles on the faces of her family told me that at some point and somehow, in the midst of actively witnessing the transition of their mother, aunt, sister, and grandmother, they ...

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For too long we have let politicians, insurance companies, lawyers, administrators, and consultants tell us what is best for our patients. Over the years, we’ve stood idly by and watched as the field we love is debased, one superfluous policy after another -- foolishly believing that if we just worked a little bit harder, we could make up for all the extra rules and regulations. We’ve dedicated our lives to ...

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