shutterstock_137226314 When teaching about life near dying, it is hard to achieve open conversation.  No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow.  While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the ...

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shutterstock_118491940 From seeing elegant pictures of our brain and spine, to definitely characterizing masses in the liver and guiding management of orthopedic issues, MRI has an established role in the delivery of optimal care. MRI is an amazing tool that allows us to see inside our bodies and helps us get answers about a wide variety of medical conditions.  As a radiologist ...

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shutterstock_142825543 I thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen. Then I became employed by ...

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We all want to practice evidence-based medicine.  Yet that phrase is so overused that one must always question the true meaning underlying the use of the phrase. The first assumption that many make is that evidence is a solid structure without nuance.  Yet we can have different experts look at the same evidence and develop different conclusions!  Why else would we have competing guidelines. Consider this quote from Nietzsche: "There are no facts, ...

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shutterstock_104230859 For those of you who have been riding along with me on my journey for the past few years , you know that it has been one heck of a ride. What started out as a little blog to encourage other doctors who were struggling with burnout has exploded. In a good way. My blog came about because I was looking for a ...

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shutterstock_144636683 Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was the patient. Isn't that the chronic back pain patient who was addicted to painkillers and got mad at me because I wouldn't renew ...

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shutterstock_181358384 In the wake of the latest school shooting in the state of Washington, much attention has been paid to the shooter’s (Jaylen Fryberg’s) Twitter account. In fact, after a school shooting, social media sites are typically the first place that people go to learn about the assailant. While this is understandable, one has to wonder if any of these school shootings ...

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The days of using your insurance to see the family doctor are numbered. As more patients join the practice and I hear each new patient’s story, I become more impressed with the benefits of direct primary care for both the patient and the physician. Recently, a 63-year-old female, who we’ll call Martha, came in for a visit. Martha is an out of work chef who, due to financial hardship, hasn't had health ...

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Whatever our individual belief systems, here is a cause that can unite us. Whatever our party affiliations, this can cause us to "reach across the aisle." Whether or not we are religious, or believe in this life only or the next, this is a cause we can agree on, here and now. Conservative or liberal, right or left, theist or atheist, libertarian or green, male, female, gay, straight, we must ...

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Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists. From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s ...

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