Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices. Everyone has ...

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I am so glad that I’m only a partially conflicted, semi-neurotic, intermittently confused middle-aged psychiatrist. It would be so much harder to be a young guy, just coming out of residency, trying to decide what to do and how and where to do it. The stress! When I finished training, career paths were relatively easy to research, vet, and decide upon. You could go into private practice, in a group or ...

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I felt a woman’s uterus without her permission. How this happened, and why I thought I had done the right thing at the time, tells us something important about medical education and shows us why doctor/patient interactions often play out like conversations between earthlings and aliens. To understand my inappropriate actions, you need to know something about the physical exams that we physicians conduct on our patients. More specifically, about the ...

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It turns out that the practice of medicine is just common sense.  If someone has fallen and their hip hurts, it is probably related.   If someone does not have an infection, do not give an antibiotic.  Exercise and good food are, well, good for you.  If it is not broken, do not fix it. Usually, patients understand this basic idea.  The best chance of becoming and staying healthy is the simplest ...

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As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that ...

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I have failed Jerry, and now I'm replaying every word I ever said in my head, over and over, the whole exercise consuming my being. Jerry was not old. He just turned sixty, a good few decades of retirement awaiting him. Then, he was diagnosed with stage 4 esophageal cancer. It seemed that he had spent his entire life working up to that moment, only to be stolen away unjustly, by ...

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Sitting on a dusty wooden bench in the rural Sacred Valley in Peru with the Andean mountain range serving as a scenic backdrop, it dawned on me that I was the first physician that my 43-year-old Peruvian patient had ever seen. After treating his acute diarrhea, I was faced with his elevated but asymptomatic 162/89 blood pressure. I knew he needed treatment, but my concern was whether or not to start ...

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"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...

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Today was a great day.  Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing.  Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world.  I know.  I saw it happen today. Today, Mr. X presented with a troublesome history and an even more threatening physical exam.  I was afraid that the disease I was about to diagnose would ...

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Doctors are ... Start by entering those two words into the search line of your web browser and look at the list of the top ten searches.  What words come to mind next?  This is the list from my browser: Doctors are stupid, arrogant, evil, dangerous, idiots, overpaid, useless, underpaid, rich, greedy. This list is disappointing.  Is this representative of public opinion of what doctors are?  As one physician, I realize there is ...

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