"I can fix this." The neurosurgeon was nothing if not confident. "The cyst is pushing on your spinal cord. If it continues to expand, it will damage your nerves and you may lose the ability to walk. But I can remove the cyst, and cure you." The patient was a business school professor, a man comfortable with risk-benefit ratios and complex decisions. He probed for more information. The surgeon was happy to provide ...

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New research just out in the journal Psychology and Aging says pessimists live longer and healthier lives. If this is true, then contemplating the future of anesthesiology ought to make us immortal, because our professional prospects don’t look bright.  As we teach residents to do what we’ve always done, shouldn’t we ask ourselves honestly if we’re training them for a future that doesn’t exist? Especially here in California, it seems ...

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A phone conference had been arranged.  They wanted to talk to me about a denial for payment on a portion of a patient's pre-authorized procedure after the fact.   Its participants: the regional medical director of a large insurance company, his female assistant administrator, and me. He cordially introduced himself as a pediatrician by trade from a large well-known (and highly respected) academic institution with impeccable credentials responsible for our region of the United States. ...

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asco-logo“Great,” I thought, as I stood at my desk, looking at my patient list early in the morning. She was coming in today. “She” was a patient of mine in her forties, with newly diagnosed triple-negative breast cancer, without nodal involvement. Our first meeting had been several months ago, and it had not been a good one. I had asked about her ...

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Let's explore one of the most well-studied health behavior theories - the health belief model (HBM). The HBM states that our health choices are a direct consequence of our perceived susceptibility to a disease, our perceived severity of a disease, and the perceived barriers that keep us from adopting better habits. Perceived susceptibility, perceived severity, and perceived barriers are three of the main constructs from the HBM.  The word "perceived" is very ...

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"If you can’t do this drunk, you shouldn’t be doing it at all." The eminent professor was speaking to a friend of mine about heart surgery. He was not supporting operating under the influence, or am I. The point is that the technical component of surgery -- the cutting, the sewing, the rearranging -- is very easy. It is true that in the OR, as on the golf course, some are more ...

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A psychiatric colleague once told me that the incidence of anxiety disorders went down drastically during the blitz, when London was under constant siege by German bombs in 1940-1941. I don't know whether this is true, or even how you could measure such a thing under those conditions--but it makes sense to me. The patients I saw at Massachusetts General Hospital the day after the terrorist attacks just two miles ...

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Sometimes, when a parent tells me about something that happened with their child, I think (and say, as nicely as I can): Why didn't they call right away? And sometimes, when I'm talking to a parent or seeing their child in the office, I think (but don't say): Why did they call about this? It can be really hard to know when to call the doctor. It's hard because sometimes you plain old ...

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A divorced friend of mine who recently started dating was shocked to find that the complete absence of female pubic hair seemed to be an expectation among her potential partners. I’m not surprised, when I was in the dating pool a couple of years back there were men who actually listed full clamscaping required among the personal attributes they were seeking in a girlfriend (and here I was looking for ...

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shutterstock_100033454 I want to wake up feeling restless and uncomfortable. It’ll be neat to drag myself out of bed to open that first bottle of wine. I’ll drink all of it within an hour. Then I’ll go to the liquor store. The guy behind the counter will know that, everyday, I will buy a pint of vodka from him. He will look at ...

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