One of my most treasured stories as an ED physician belongs to a lovely couple who valued quality of life. It was a routine day in the ED when an elderly woman rolled through the ambulance doors on a cold, narrow stretcher, unaccompanied by family. She was placed in bed 5, which is where we met. She was frail and her memory was poor. The EMS run sheet reported “change ...

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Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests -- I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family ...

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Q_GVE0837-136-1024x701 I’ve always been a people watcher. Now I get paid to spy on folks. I have to ask detailed, personal questions. Sometimes I even snoop around patients’ homes. In the 1930s nearly half of all patient visits were house calls. Now most patients are rushed through ten-minute office visits. But if I need to know what’s going on with a patient, I ...

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It’s been almost two years since returned to medicine after a three-year hiatus from practice.  I recently finished the longest week of work I have had since starting this job.  I had a family emergency and a conference all converge around the same week, and ended up cramming two makeup days into an already full schedule.  It was long.  It was incredibly tiring.  I was very glad when I finally ...

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As I look back, I remember teachers.  One taught to be compulsive and complete.  Another, calm and humor in the face of chaos.  Another believed in me and thereby taught me to believe in myself.  One made me write and rewrite.  Above all, there was a mentor who opened my heart and eyes to the need for compassion.  That special teacher was Dr. Black. Tuesday afternoon, 8:30am, July 12, 1966:  Dr. ...

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This article is making the rounds among physicians on Twitter. Much of the information in the article, unfortunately, is accurate. For some of the reasons stated there, I left the “traditional” health care system and pursued work at the “fringe.” Part of this is due to my clinical interests: I like working at the intersections of different fields. For example, I like the intersection of psychiatry and hospital medicine, which is called 
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Having worked with radiologists a lot, I have great respect for their specialty. The job is indeed a very difficult one. Without seeing the patient (the most difficult part of what they do), they have to thoroughly comb through every image put in front of their eyes and give us their assessment of what’s abnormal and what’s not. Their interpretation will be one that other doctors will hang their hats ...

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Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and ...

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Through three years of medical school, I’ve seen disgruntled physicians repeatedly slam the recent movement toward patient satisfaction. In our family medicine clinic, a copy of Dr. William Sonnenberg’s essay “Patient Satisfaction is Overrated” hangs on the door to remind attendings, residents, and students of the unfair pressure to keep patients happy despite their demand for antibiotics, imaging studies, or narcotics. The only way to keep the patients satisfied, the argument ...

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The day I graduated from medical school and walked across that stage with my diploma in hand, I was sure that I had achieved the highest honor in the land.  I could not help envisioning myself in a long, crisp white coat, walking down the long hallways of the hospital, with my name badge perfectly displayed that read: "doctor." I was certain in my mind that I had finally made it.  ...

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