William would come to see me every three months for his COPD (chronic obstructive pulmonary disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her. On one visit he said, "Doctor deMaine, can I tell you something - and promise you won't think I'm crazy?" "Sure." "Well, my wife ...

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shutterstock_85837342 Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides.  Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion. The ...

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I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.) My first reaction was to be impressed by this bold progressive move. My next reaction was to feel mildly ...

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Sometimes the health care system just does not work. I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two ...

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Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston's South End. I consult my iPhone one more time to confirm that I'm in the right place and knock on the vehicle's glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on ...

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Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position ...

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shutterstock_108241016 I have come to terms with making difficult decisions.  I accept the possibility of committing a mistake that will cost a life.  But I never signed on to bankrupting my patients.   Never! I had been up all night tossing and turning.  The stat CT scan was deemed unnecessary by the insurance company.  My patient called crying saying he couldn't afford the thousands of dollars in charges.  Never ...

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I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months.  She was bidding me adieu, because I had referred her to hospice. There is confusion about the role of the primary doctor, when a patient ...

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An excerpt from When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a ...

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Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it. In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their doctor. That’s ...

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