She had only been in the hospital twice in her life: once when she was nine and now, 60 years later.  She had gotten tonsils out then.  She was getting tumors out now. Her abdomen hurt when she was awake.  Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia.  Her body would feel it, though, and could respond by dangerously spiking ...

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Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That's what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give ...

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For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management.  It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on ...

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It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour. The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop. “I’ll let the ...

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About thirty years ago, after I'd completed my internal medicine residency and a rheumatology fellowship, my wife and I moved with our three-year-old son to my wife's hometown. There I joined a multispecialty group practice as the second rheumatologist. Over time, the plan was for me to build a rheumatology practice, but while that was happening I took on all kinds of patients, both primary-care and intensive-care. I felt very comfortable ...

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The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and Martin Luther King’s famous speech might have been entitled, “I Have a Strategic Plan and ...

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To hospital administration, I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family.  Unfortunately, I do not qualify for any of the exemptions allowed by our facility.  Since I am not religious, I have ...

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I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over. Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next ...

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Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.” This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management ...

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Click, click, click, “Hello, how are you today?” Click, click, click, “How long have you had a sore throat?” Click, click, click, “Have you had a fever?” Click, click, click, “Have a seat on my exam table, please.” Click, click, click, welcome to my day.  Let me introduce myself, I’m a professional clicker.  I used to be a member of a highly respected and sought after profession; a doctor.  The modern world of government/insurer ...

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