It happened again today.  A youngish man, age 59 (youth being relative these days) comes in for a consultation.  His history began eighteen months ago when he started to notice hoarseness.  Thinking he had laryngitis, he saw his primary care doctor.  He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory ...

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As far back as I can remember, I've deliberately spent my life on the high road. I was the seventh-grader who was told by adults that she was very serious. I was the college student who majored in chemistry because it was the strongest premed major. I became a doctor. Before becoming a doctor, I imagined that I would be the epitome of compassion. I envisioned pausing for a moment before ...

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Terry is a particularly difficult patient.  She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff.  No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult ...

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I have nothing against the patient empowerment movement.  In fact, I think an informed and collaborative partnership is mutually beneficial.  But I can't help but laugh when I read some of these tweets. Death to paternalistic medicine! The age of paternalistic medicine is over! True, the era of doctor knows best is long gone.  But it's a mistake to think think today's health care consumer has any more leverage than before.  It just seems ...

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I mustered up the courage to visit Mary today. Pulling into her driveway, I was greeted with the majesty of autumnal brilliance—golds, rusts, and crimsons set against a brilliant azure sky. A bold display of nature’s defiance against the upcoming long winter’s sleep. Not to be ignored, those leaves that had flamed out early chattered against my every step as I slowly ambled toward the doorway. I took a deep breath and ...

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Sorry for not posting for a while.  It’s not that things have been quiet; they definitely haven’t been. Here’s the update:

  • The construction has been delayed, so the office will open on the 28th of this month at the earliest.  Inspectors are a pain in the buttocks.
  • This delay has kept me from hiring staff, as I need to have a solid start date for them.
  • The extra time has allowed me to do ...

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A sample agenda as the consulting psychiatrist at a geriatric adult home: 8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull the door open. Say good morning. She never sounds cheerful when she replies, “Good morning.” Because there is no open stair access, take the elevator up one floor. It travels ...

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Like most Americans, when I learned that twenty children and six adults had been massacred in Newtown, Connecticut, I recoiled. Like most parents, my next thought was for my own son, the image I retain of his happy, smiling self for one moment replaced by an image of his tiny body lying twisted on the ground. Even as I write these words, an emotion I rarely feel—one I often can’t ...

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I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured ...

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I recently heard from an aging and respected physician the old adage that “what is good for the doctor is good for the patient.” The room full of physicians of all ages and specialties nodded their heads in agreement. This saddened me, as it represents a physician-centric system that oftentimes leaves the patient’s needs and desires completely out of the equation. An area of emerging importance in medicine, whose impact should ...

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