In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency. At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc. For those that don’t choose a subspecialty, one choice remains: traditional ...

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Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently ...

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When I first learned that the U.S. was going to develop a new specialty, the hospitalist, I was very pleased. I had long believed from study and direct observation that some of the better healthcare systems in Europe were benefited in a major way by the general separation of office and hospital medical practices and practitioners. In the U.S., historically most patients have been taken care of by physicians practicing medicine in ...

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"When is it time to break up with your doctor?  It can be a tough decision to make.  After all, if you don't like your experience at a store, you shop somewhere else next time.  If you go for a haircut and hate it, you find someone else. With your doctor, it's a bit different.  This is someone who might know some of your deepest, darkest secrets.  There is a history ...

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Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes. So it is natural that patients have a hard time understanding it as well. Therefore, I decided to summarize a conversation I had with a patient in an effort to help other patients understand, at the very least, a portion of how medical health ...

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Sex sells. US Weekly and People fly off the shelves with the latest reality star drama.  Unfortunately, the same does not apply to the diseases running rampant in today’s society.  Is there an answer?  I would like to say yes, but the ultimate answer remains to be seen.  After my four years of undergraduate work and four more years of medical school, I am confident that there are a myriad ...

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In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for "Big Barn") still retained ...

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Although as a medical student rheumatology was always associated with an air of mystery and complexity to me - factors which might have aroused a younger me had they been associated with a member of the opposite sex – the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980′s, rheumatology wouldn’t have got as far as a first ...

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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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