When it comes to doctor- nurse interactions, when is enough, enough? Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to ...

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There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem.   To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future ...

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"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...

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I took a deep breath. I had to think carefully. It's not that this was unexpected - Johns Hopkins has been anointed the country's best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution. One truth, however, cannot be denied: to call one hospital the best is not simple. Let's ...

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What causes a doctor to commit suicide? A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in ...

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It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms.  In a hospital setting, these are cases for discussion and debate at Grand Rounds.  In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning.  The bottom line, whether in a formal academic setting, or an informal setting around the lunch ...

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Almost four years ago now, I left my practice as an emergency medicine physician to enter the business world.  However, the medical world isn’t easy to escape.   I just couldn’t seem to forget some of the problems I used to face in the emergency department.  So, when I had the chance to fix one of them, I took it. The most intractable problem for me was fraud, especially as it related ...

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Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term "fat," "obese," or "morbidly obese" because they were stigmatizing, blaming, and the least motivating to ...

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Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman's hair. She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia's eyes opened and closed in an exaggerated blinking manner as she questioned me ...

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I have a 5% chance of having a heart attack in the next 10 years.  That’s not so high, but it’s higher than I want it.  Most of that risk is due to my cholesterol and my age.  I can’t do anything about the latter, but the former is under my complete control.  Cholesterol medications can improve my cholesterol significantly.  So can proper diet and exercise.  That’s not true of ...

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