"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...

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Today was a great day.  Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing.  Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world.  I know.  I saw it happen today. Today, Mr. X presented with a troublesome history and an even more threatening physical exam.  I was afraid that the disease I was about to diagnose would ...

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Doctors are ... Start by entering those two words into the search line of your web browser and look at the list of the top ten searches.  What words come to mind next?  This is the list from my browser: Doctors are stupid, arrogant, evil, dangerous, idiots, overpaid, useless, underpaid, rich, greedy. This list is disappointing.  Is this representative of public opinion of what doctors are?  As one physician, I realize there is ...

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After years of breaking down, my sedan recently died.  Finding myself in the market for a new car, I did what most Americans would do – went to the web.  Reading reviews and checking rankings, it quickly became clear that each website emphasized something different: Some valued fuel-efficiency and reliability, while others made safety the primary concern.  Others clearly put a premium on style and performance.  It was enough to ...

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Besides discipline, what would you say is the one thing that all athletes have in common? All Olympic athletes have a coach. I find this interesting. Here we have the most elite athletes in the world. Most of them have trained for most of their lives, others are repeat Olympians, and others are repeat medal winners. Yet they still have coaches. Why would they need coaches? Surely they know what needs to be done ...

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It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents.  There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training).  The aspect on my mind at the moment is the role of clinic preceptor. When I was new to the role and new to the clinic, I was paired with a more experienced ...

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I have been installed as President of the Alabama Academy of Family Physicians. The work should not be too hard and on occasion should be rewarding (or at least ego-boosting). Such was the case the other day when the executive director asked me to recall a patient from “my early days” that had made an impact so he could publish my thoughts, thus officially making me an old geezer. I ...

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My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine - healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He ...

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If you're a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article "Big Med" is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the "Cheesecake Factory" in our policy medical meetings, conferences, PowerPoints and bloggery. What he wrote Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately ...

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Once again, legislators are meddling into healthcare. This time, it’s in my own home state, where Governor Cuomo has just signed a bill requiring radiologists to notify women when their normal mammogram also shows that they have dense breasts. In such cases, the following text must be included in the lay summary mammogram report given to the patient: “Your mammogram shows that your breast tissue is dense. Dense breast tissue ...

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