An excerpt from ASSUME THE PHYSICIAN: Modern Medicine's "Catch-22". “What did you learn today?” I asked, fearing the answer. I was suspecting a recitation about the new methods of documenting nursing competencies, or a delineation of the process by which she helped the hospital maintain its “magnet” status to attract more ...

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This post is a question, an invitation and a challenge. How can we bring technologies we take for granted back home to those in the developing world? Many before me have spoken with outrage about the reality of two worlds: one of abundance, and the other where people live like they have in centuries past. The situation is more complicated since even poor people may have some technologies like cellphones now, but vital lifesaving technologies ...

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Incoming telephone calls should be a good thing in a medical practice, right? Requests for appointments from new patients and established patients are the lifeblood of the practice. But for many practices, the phones are an overwhelming burden for everyone, from the receptionist and nurse to the provider with an inbox full of patient messages to sort through. In general, approximately 25% of incoming calls to a medical practice are repeat ...

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Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags. Not where I usually spend my days. I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their "experience" during their visit to our practice. Everybody here wants the same thing, ...

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You’ve heard the story before: a young man or woman with idyllic dreams of practicing primary care goes off to medical school, only to have their dreams crushed by the realities of 7-minute visits, “production goals,” and unstable reimbursement -- you’ve heard of the Medicare sustainable growth rate, or SGR, right?   Every time you turn around, there is someone talking about primary care physician burnout or complaining about practicing on ...

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I’m coming out, but it isn’t what you’re thinking.  I’m writing this to finish answering a question that I was asked 25 years ago by an attending physician.  He was a Scotsman with a ruddy complexion and it was early in my third year of medical school.  I had been up since 4am rounding on patients and then assisting on a general surgery case. Answering the esoteric questions the Scotsman posed had ...

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Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is  unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels ...

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Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain.  His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab.  In the interim, his chest pain worsened.  Sure enough, he developed an anterior MI.  The tombstones ...

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I love digital media. I love my iPhone and my iPad. And as much as I admire those who go on digital vacations, I’m not going to do so anytime soon. But I had two moments recently that made me realize that we all need to take a closer look at our digital habits. The first was when I was leaving work one evening. As I waited at the crosswalk outside ...

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The exam room and hospital bedside are usually non-partisan zones. Though there have been exceptions -- anti-nuclear activists Dr. Benjamin Spock and Dr. Bernard Lown come to mind -- physicians tend not to be particularly political people. And even when they are, their politics don't usually intersect with their clinical work. When President Reagan was shot and joked with surgeons, "I hope you're all Republicans," the response from one doctor (a Democrat) ...

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