After years of breaking down, my sedan recently died.  Finding myself in the market for a new car, I did what most Americans would do – went to the web.  Reading reviews and checking rankings, it quickly became clear that each website emphasized something different: Some valued fuel-efficiency and reliability, while others made safety the primary concern.  Others clearly put a premium on style and performance.  It was enough to ...

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Besides discipline, what would you say is the one thing that all athletes have in common? All Olympic athletes have a coach. I find this interesting. Here we have the most elite athletes in the world. Most of them have trained for most of their lives, others are repeat Olympians, and others are repeat medal winners. Yet they still have coaches. Why would they need coaches? Surely they know what needs to be done ...

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It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents.  There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training).  The aspect on my mind at the moment is the role of clinic preceptor. When I was new to the role and new to the clinic, I was paired with a more experienced ...

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I have been installed as President of the Alabama Academy of Family Physicians. The work should not be too hard and on occasion should be rewarding (or at least ego-boosting). Such was the case the other day when the executive director asked me to recall a patient from “my early days” that had made an impact so he could publish my thoughts, thus officially making me an old geezer. I ...

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My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine - healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He ...

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If you're a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article "Big Med" is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the "Cheesecake Factory" in our policy medical meetings, conferences, PowerPoints and bloggery. What he wrote Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately ...

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Once again, legislators are meddling into healthcare. This time, it’s in my own home state, where Governor Cuomo has just signed a bill requiring radiologists to notify women when their normal mammogram also shows that they have dense breasts. In such cases, the following text must be included in the lay summary mammogram report given to the patient: “Your mammogram shows that your breast tissue is dense. Dense breast tissue ...

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Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves.  They will need extra help with their activities of daily living either from ...

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Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child's face. A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor. As such, the plastic surgeon is called in and sutures up the face beautifully. The child and family ...

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Many recent conversations in the advancing world of health care delivery have integrated the term "disruption." At first glance, this is perhaps quite jarring and counter-intuitive to the mind of the forward or progressive thinker. It is ever the more uncomfortable to the medical mind that is trained to carry on in the face of adversity, through exhaustion, and despite resistance. Paradigmatically, the medical world has recently been presented with ...

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