Historically, American physicians and surgeons were fiercely independent practitioners, who owned their own practices, worked long days and maybe longer nights, made a good income, but saw little of their families. They trained in a male-dominated world in "residency," so named originally because their extended 120 hour/week work schedule demanded them living in dormitory type residence adjacent to the hospital. They developed long-standing professional commitment to their patients that superceded time ...

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In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab.  I’m talking about cancer survivors-- a group of individuals known for their tremendous advocacy abilities.  It’s no surprise that these folks are really starting ...

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Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective. Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with ...

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My wife has two world-class oncologists who help her manage her stage 4 lung cancer.  Both are excellent clinicians.  Yet their skills differ in one very important way.  Her radiation oncologist physically touches her a lot (in a good way of course!).  There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam.  Her medical oncologist not so much. We all ...

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Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine.  The article has received (as expected) mixed reviews, because the concept causes angst for some physicians. I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system.  Retainer medicine is a response to burnout.  Yes, many retainer physicians are making more money.  Is ...

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I am a third world doctor. My patients have first world expectations. Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations. In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn't feel its own failure, ...

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Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011? a. Feeling of insufficient medical knowledge b. Health system reform c. Educational debt d. Availability of free time e. Dealing with patients If you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey ...

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At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient's room and give a shot of morphine. This ...

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Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology. My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked ...

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The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us.  But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse. No one in modern America expects a child to die.  Children only die in nineteenth century novels and third-world countries, or ...

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