I click open the x-ray viewer.  After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam.  Yet I audibly gasp as the chest x-ray loads.  The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes.  I begin to count the fractured ribs -- 1, ...

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Why must everything be so difficult? Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face.  The wheelchair appeared preposterously large for the aged figure cowering under the haggle of blankets.  They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out.  Her lips curled and she moaned deeply. Now Soni's mother had stopped talking ...

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One of the most satisfying sports is to make ourselves feel better by degrading another.  What better way to make up for our own inadequacy, then to shove someone else’s face in theirs?  We see this at work, in our families, in politics and in almost every type of social interaction.  Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is ...

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You may have missed this when it first appeared. Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of health care may be wrong. Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce health care spending. According to the report from the National Center ...

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I nearly died a month ago on a treadmill halfway through a stress test. The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours ...

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“First, do no harm,” as suggested by Hippocrates, is a vital principle that should always guide physicians, but they are also well aware that in modern health care, whether in the form of drugs, operations, radiotherapy or any other form of treatment, there is always the possibility of causing harm to their patients.  All drugs have potential adverse side effects and all surgery carries risk.  Doctors and patients need to ...

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I heard the verdict in my car, driving from my birth home, Washington, DC to my new home, Baltimore, MD. I was stunned, my mouth agape and my mind muddled. Not guilty. Thoughts raced that hot July night, but mostly I cried and prayed. That Sunday morning I awoke with some clarity, but more sadness and more determination to try to fix this perceived wrong. Reaching out for stability and peace that ...

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It happened out of the blue, as such experiences often do. I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in ...

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The first thing we need to do is analyze what’s broken. Let’s approach this problem as if it were a patient in our office. It’s our job to deliver a diagnosis based on the patient’s problem. That’s easy; we’re doctors, after all. "So, what seems to be the problem today, Mrs. Smith?  How can I help you?” “Well, it seems that no matter how hard I try, I can’t make progress. I want to ...

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When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can't be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out. To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. ...

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