I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills ...

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You are in charge of your own healthcare. Equally important is research that reveals that most women are in charge of their family’s health as well. But you’re not alone – you need a physician partner for you and your family, and sometimes, it can be challenging to find the right one. I always recommend doing your homework and researching the reputation of the physicians, surgeons and nurse practitioners who will ...

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Last year, Texas legislature attempted to pass a bill that would halt all funding for the Women’s Health Program, a Medicaid associated program that provides annual exams and contraception for all reproductive age women that qualify, simply because Planned Parenthood participated in the Women’s Health Program.  This puts programs such as where I work in a bind.   The funding is in serious jeopardy of being eliminated completely. According to the Texas ...

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As I contemplate retirement from clinical practice as a general surgeon, something I've been doing for over 41 years including residency, I've been having some unsettling thoughts. Like many physicians, I've tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long. I have written in a previous blog about the ...

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Are you familiar with the trolley problem? It is an ethics dilemma first formulated by the great Philippa Foot as a part of a series of such dilemmas. Her formulation goes roughly like this. Imagine there is a tram hurtling down a track. If it keeps going straight, it will hit and kill 5 people who are working on that track. The conductor is able to ...

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Despite the best evidence, oncologists cannot dictate treatmentDuring Multidisciplinary Gynecologic Oncology Tumor Board at Massachusetts General Hospital, a case was presented of an older woman with stage IV ovarian cancer who was deemed inoperable. Following review, we recommended a course of chemotherapy. I asked our fellow what treatment she would administer, and this sparked a discussion on how patients and providers create a treatment plan. We discussed options, ...

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What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients ...

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While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered - an approach honed over ten years of marriage to an internist and dozens of pediatrician visits for his two little boys. He asked smart questions that used medical terms to earn their respect, he told me. He was appropriately deferential, admitting his lack of clinical experience. ...

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Janus is the Roman god of doors and gateways but also the god of beginnings.  Interestingly, good beginnings and required for good endings.  The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day.  Most statues of Janus show him with two faces facing opposite directions. The Janus principle in your medical practice is the idea of ...

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By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice? A nurse practitioner is a registered nurse who has completed graduate-level education and advanced-practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, hospital ...

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