The creatures cause pain by being born, and live by inflicting pain, and in pain they mostly die. –C. S. Lewis The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God. The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem ...

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1797322_10202053927164294_2111408475_n Fact: Doctors want to help people. Fact: Some people take advantage of doctors. A doctor in Oregon shares this case:

I had an old man with cancer. He kept complaining of pain as I was increasing his opiate pain medication, Oxycontin. I was at, I forget, about 40mg four times a day or some fairly substantial dose. I ran a urine drug test. Negative ...

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Think for a second about the most treasured drug or device in your medical bag.  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate ... and I do. I also enjoy doing ...

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Many times I have heard physicians and other providers lament that the outcomes for their patients would be so much better if they could “get them to listen and follow instructions.”  They understand that they can be most effective in treating patients if the patients would follow all of their directions. Do the physicians’ or care providers’ responsibilities end with this wish?  Can physicians do more than just hope and pray ...

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There is a JAMA article out that is very telling: Medical Conspiracy Theories and Health Behaviors in the United States. It is a must-read article for anyone who wonders why the public does not seem to advocate for themselves when it comes to their medical care in the US. The first theory studied in the article states that the FDA is purposely preventing the public from getting natural cures ...

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There are reports from across the country regarding severe influenza in young people. In addition to mechanical ventilation, many are requiring extracorporeal membrane oxygenation (ECMO). Given the severity of illness and the presence of multiple organ dysfunction, relying on an oral antiviral for influenza therapy seems unwise. However, at this point, the only option for intravenous therapy is IV zanamivir, which is not approved by the FDA, but available on ...

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It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors -- in what they only half-jokingly called “Doccupy” -- that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. ...

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The New England Journal of Medicine recently published an article by David Reuben, MD and Mary Tinetti, MD, both academic gerontologists, about patients who are unable to stay out of the hospital. The two physicians study the problems of old people, and are of the opinion that most of these "hospital dependent" patients are elderly. Certainly some of them are, but in my experience a surprising number are just chronically ill, ...

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During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence -- this fear of what’s ahead -- ...

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The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends -- so he told me at every visit. His visits ...

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