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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“Never sign anything without me reading it first.” Cautionary words from my husband, an attorney, whose ability to read and interpret the fine print has saved my life, so to speak, on more than one occasion. That all-in-the-family attitude toward a profession is something almost every doctor also knows well. Through me, my husband, relatives, friends, and sometimes acquaintances can get what I call a “healthcare quickie,” a free, two-minute sideline. They can ...

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GVE8814-948x1024 As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love. During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the ...

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My friend breathed a sigh of relief as she finished her last clinic visit for the day and headed down the hall to the physician workroom.  It was only 5pm.  She still had notes to write and labs to check, and as a senior resident she needed to make it back to the hospital wards to check on her team’s interns, to get updates on the afternoon’s events and help ...

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Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades. Robert E. Tarone at the National Cancer Institute (who isn't a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography ...

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Recently, a patient I have known for several years called my office and spoke to my nurse. She said that while she was driving, her vision had gone blank for one second and then she was fine. My schedule was already overbooked. Almost all of the slots were filled with patients with the usual array of multiple chronic medical problems for follow-up and management of what were, for the most ...

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asco-logoI still remember being taken aback by how young she was. “She” was Mary -- a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion. “I’m still getting used to this area, but I am happy my hair came back before we had to move. I ...

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Sorry for the long gap between blog posts. I have been distracted by the volume of work that I have had to do.  Is that a good thing? Yes. Is it a bad thing?  Certainly. I recently heard an interview of Mark Cuban, the owner of the Dallas Mavericks basketball team, billionaire entrepreneur, and one of the "sharks" on the show "Shark Tank." The show involves entrepreneurs the opportunity to pitch ...

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As part of a family medicine rotation, we recently discussed the importance of bringing spirituality into the hospital. The conversation was led by Stanford Hospital’s chaplain, Dr. Bruce Feldstein, an ER doctor in a former life. We began with definitions of spirituality, discussed personal experiences surrounding a spiritual moment, and concluded with how to take a “spiritual history,” a series of questions that explore patients’ spiritual or religious beliefs. We even ...

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