There’s a great song by Don McLean called "American Pie.” The chorus talks about “the day the music died.” I thought about that song in my hospital a couple years ago, when the music died there, too. I’ve noticed that our physician burnout and nurse frustration have increased in the years since the music died. Could it be a coincidence? McLean’s song was about a plane crash in 1959 that claimed ...

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shutterstock_255158716 A medical student asked to speak to me about a month ago at the Philadelphia College of Osteopathic Medicine, where I am an instructor of family medicine. He has been very active in our school’s Primary Care Scholars program and community health outreach activities. “Dr. Chan,” he said, “I am so torn. I really love primary care, but I am so ...

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Mr. Dwyer isn't my patient, but today I'm covering for my partner in our family practice office, so he's been slipped into my schedule. Reading his chart, I have an ominous feeling that this visit won't be simple. A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath. He suffers from both congestive heart failure and renal ...

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Her heart was failing; her ejection fraction was unmeasurable.  Her hip was broken, and she developed a pulmonary embolism post-operatively.  She was painfully close to death.  Yet at some point, the hospital finished and spit her out at the nursing home. She was confused. I tried to take the best history that I could.  Her answers where usually no more than a single word.  Her physical exam revealed a desperately weak woman, ...

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shutterstock_136759886 As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged ...

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Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that? Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren ...

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shutterstock_154811264 We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at ...

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Patients admitted to the hospital ward sometimes get sicker instead of getting better right away.  Often this can happen acutely. Depending on the circumstances, ranging from a "rapid response" for unstable vital signs to a cardiac arrest (a "code”), previously uninvolved hospital staff might be called on to help.  Despite the commotion, these events are a period of time for the health care team to shine.  At inpatient emergencies, ...

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You live like this, sheltered, in a delicate world, and you believe you are living ... And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death. - Anais Nin On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation.  About 50 meters in ...

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shutterstock_22233682 This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift. Fresh out of residency, I had accepted a job in the ER of a community hospital which -- though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview -- had turned into exactly the opposite when I ...

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