As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come ...

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shutterstock_136130633 A small case with big implications almost escaped my notice recently  The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection. According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains.  OK, stop right there all ...

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Well over a year ago, I advised my 80-year-old patient and her children that due to progression of her Parkinson’s disease.  Because of her frail nature, she needed a higher level of assistance and care if she wished to remain in her home.  She was extremely unsteady walking and several courses of physical therapy had not improved the situation. The patient was feisty and would only allow help to come ...

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In my core, I always loved doing surgery, and being surgeon to my patients. As I hope I've made clear in my blog, I was always amazed that I was allowed to do it, and awed at the mysterious beauty of it all. As much of a responsibility as it is, it's also an inexplicably wondrous honor and privilege. Those words aren't lightly written. But in a diabolical ...

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Next in a series. The primary care physician (PCP) is the most broadly yet deeply focused care giver and as such is the the backbone of the healthcare system. But to do this work effectively requires time -- time which all too often is not adequately available. What constitutes primary care and who are the primary care physicians? They are the first responders, the first line of care, and very frequently ...

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You have to earn your cynicism.  That’s my rule.  Young pre-med and medical students, even some residents don’t have the same right to cyncism as the rest of us who have labored in emergency departments for years, for decades.  The same goes for nurses fresh on the job from training, and ward secretaries who so recently were high school kids. It always troubles me when these people start working in our ...

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His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school -- and threw on an MBA for good ...

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This month, the literature and medicine group at my hospital met to discuss Arthur Miller's Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with "a shoeshine and a ...

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I was a work today and I was given this message, “ —–'s husband called and wants you to call back right away!  He sounded very upset.  His wife died.” Uh oh, I thought to myself, this is never good.  It was a patient I remembered well, that I had seen repeatedly for a chronic problem, and who always came with her husband.  We seemed to get along well.  I didn’t ...

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As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality? In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually ...

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