Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

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An excerpt from So Long, Marcus Welby, M.D.: How Today's Health Care Is Suffocating Independent Physicians - and How Some Changed to Thrive. A 30-ish public-relations executive representing a large, modern physician practice was shaking her head in puzzlement. Her physician client liked to talk about how his practice was not "a ...

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shutterstock_79545058 While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde. I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training ...

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Part of a series. In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case ...

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I don't like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician.  I like to play Sherlock Holmes and figure out what's going on with people, and I think I'm pretty good at it. So I lied.  I do like to brag ... a little. In most people's mind's eye, the role of diagnostician ...

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As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult. But the importance of this task should not be overlooked. ...

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In a recent post, I wrote about the value of a yearly checkup with your child’s doctor -- it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips. First, and most important at all, go to the visit. You’d be surprised how often children are brought by ...

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California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us. I have no objection to this new requirement, if it passes. This will not be ...

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"Dad, you have the nicest patients!" She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what's important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been over ten years since I had my first "bring your daughter to work" experience.  Her first time ...

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We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. - Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst. The expression, “the devil is in the details” implies that the details can ...

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