For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother.  She called while I was at the mall with my family doing some last minute shopping—I ...

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As a pediatrician at a busy county clinic with close proximity to pediatric specialists, I care for a significant number of children with special health care needs. Instead of colds and ear infections (though there are those too), my days are often filled thinking about gastrostomy tubes, tracheostomies, and ventriculo-peritoneal shunts. I sign orders for specialty formulas and nebulizer machines. Many of my patients have thick charts and diagnoses like ...

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A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch. And I agree. Comparing guns and cars is fair, after all they kill about ...

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Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here. First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies ...

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Don’t be surprised if patients start asking more questions than usual about awareness under anesthesia.  We can all thank a recent article in The Atlantic magazine, with a large-print headline on the cover:  “Awake Under the Knife”.  Written by a UCSF medical student in preclinical training, the article not only assures everyone that awareness can happen, but takes pains to point out that anesthesiologists can’t always prevent it. The ...

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It’s showtime.  No need to worry.  This is just another routine performance.  I can do this.  All I need to do is get on stage, do my dance, and wait for the curtain to fall.  Then move on to the next stage and do it all again. The curtain opens. My patient is wheeled into the operating room.  With the help of the circulating nurse, we guide her from the hospital gurney ...

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shutterstock_111707921 An article written by two physicians in Time questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications. There are two frames of reference to this article. First, no one can argue that prescriptions for pain medications in this country are excessive. The article notes that in 2011, "enough hydrocodone was ...

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shutterstock_98508239 Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF).  According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs.  One monthly cycle of this treatment will run ...

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Protected naptime is a luxury usually reserved for the under-five-year-old set. Might it also be a tool to combat our country's astoundingly high rates of medical errors? Trainee fatigue has been a major focus of patient safety efforts since the mid 1980's, after 18-year-old Libby Zion died tragically from a drug interaction that may have been precipitated by residents working long hours. In 2003, the Accreditation Council for Graduate ...

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shutterstock_17897284 Today I've been feeling stupid. My job absolutely requires critical, creative thinking and the ability to focus well, which was really hard today. But I don't think I'm actually stupid. I think it has something to do with the task at hand. So this is how today went. I think it kind of explains the stupid feeling. My morning shift started at 7:30am in ...

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