“I’m so sorry, but it looks like the cancer has spread.” As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that I was talking to. I looked at his face and saw that he was trying to remain strong, but in his demeanor, it was apparent that dreams were crushed and that ...

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Summer, 1998 Three Rivers Stadium Pittsburgh, Pennsylvania It was a typical Saturday morning on call. We'd finished rounds and I'd taken the sign-out from the resident who'd worked the night before. I headed to the library, planning to do some board prep before the inevitable beeper call to the ER or ICU. I was a PGY-4 neurosurgery resident, with many previous weekends on duty to my credit. No reason to think this one would be ...

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I recently spoke to a quality measures development organization and it got me thinking -- what makes a good doctor, and how do we measure it? In thinking about this, I reflected on how far we have come on quality measurement.  A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or ...

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Malcolm Gladwell thinks we should tell people whats it's really like to be a doctor.  And by God I have invested the last seven years in doing just that.  I have written countless blogs, given lectures, and traveled to Ireland.  I have coined the term Caring 2.0 to describe the bidirectional flow of empathy.  Patients will tell us what it is like to suffer with disease, and we ...

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I believe that family medicine is the solution to American health care. I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care to specialty care have populations who live longer and health care that costs less. Too many specialists and not enough family physicians leads to unnecessarily expensive care and shorter life expectancy. I believe that family doctors provide something intangible to our ...

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I have a confession. It is a secret I have held for more than 10 years and it is a lesson I have learned from other women. As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise ...

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Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients. But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, ...

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They used to tell us, as physicians, that "if it isn’t on the chart, it didn’t happen."  We could protest all day, to billing companies, insurers or attorneys, "I did that.  It’s assumed.  I always do the same thing every time."  But they would retort, "nope, it’s not in the chart."  So we learned to detail everything, every time, every movement.  Every consideration and justification.  The idea being, our ‘thought process’ ...

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“I walked in a person, and out a cancer patient,” my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine -- the side on the exam table or gurney, as opposed to the one standing over it. As a physician I was used to the latter. This is my family’s story in our new position, and how the cost of medical care has impacted ...

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Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way ...

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