I have the privilege to work in the medical profession where astonishment and revelation awaits me behind each exam room door. In a typical clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient.  I must peel through the layers of a person quickly to find the core of truth about who they are and why ...

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shutterstock_86514196 I know. I know.  Medicare is the insurance that all of us love to hate.  But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons: 1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while ...

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shutterstock_111131156 Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics ...

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shutterstock_77508028 Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner. When there is bad air in the mine, the canary's sensitive lungs will cause ...

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William would come to see me every three months for his COPD (chronic obstructive pulmonary disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her. On one visit he said, "Doctor deMaine, can I tell you something - and promise you won't think I'm crazy?" "Sure." "Well, my wife ...

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shutterstock_85837342 Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides.  Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion. The ...

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I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.) My first reaction was to be impressed by this bold progressive move. My next reaction was to feel mildly ...

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Sometimes the health care system just does not work. I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two ...

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Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston's South End. I consult my iPhone one more time to confirm that I'm in the right place and knock on the vehicle's glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on ...

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Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position ...

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