For 25 years, I have taught medical students how to give bad news.  Step one: Be prepared.  Step two: Find a safe, personal, quiet environment.  Step three, and this is most important: Before you speak, ask.  What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind.   So, therefore, you might ask, if I have such wisdom and experience in this critical area ...

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I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I ...

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It’s 2015, and we’re talking about measles. Not Enterovirus. Not Ebola. Not RSV. Not influenza. Instead, we’re talking about a historical virus that was declared eradicated from the United States in 2000. Most pediatricians who began practicing within the last 15 years have never even seen the disease. Measles starts as a high fever followed by a cough, runny nose (coryza), red and watery eyes (conjunctivitis), and tiny white spots inside the mouth ...

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shutterstock_117500125 As a physician, you have endured many years of schooling, and you have received many A’s on your report cards. You have passed exams with flying colors, and you have pleased your higher-ups in the food chain. You have come so far, and you now find yourself in a rarefied position that most people only dream about. So what’s standing ...

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shutterstock_131910137 American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time. In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is ...

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Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient ...

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One of the cornerstones of the practice of medicine is finding imperfection in things. When the doctor encounters the patient, the latter expects the former to find out what is “wrong.” In fact, I often see a patient and find nothing wrong, and when I voice this out loud the parents often ask, “Are you sure?” I completed medical school over 7 and a half years ago. During that time I’ve ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The health care landscape is changing, and now more than ever we as physicians should be focused on quality of care and ensuring the safety of our patients. Anesthesiology was the first medical specialty to champion patient safety as a specific focus. Over the past century, physician ...

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I remember one day a few years ago when I was talking with one of my friends about the challenges of being a doctor after a tough day at work. I had seen a large number of patients within the span of a few hours, and in addition to many of them being sick, I dealt with family members who had so many questions and who wanted to provide me ...

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shutterstock_224345509 I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience. One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I ...

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