In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park. Only ten minutes earlier, when we first met, Mr. A had been weary, his face drawn, and his speech so quiet that the sound of the aortic balloon pump keeping him alive made it nearly impossible to ...

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People lie. Patients lie.  Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear. A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on.  Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all. Providing primary care to patients on the furthest margins of ...

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knife-and-fork A few years ago I was engaged by the director of a residency program in my community to teach the program residents table manners. Now, you may wonder why medical residents need to know how to navigate a dining table gracefully. But good table manners are a must for professionals in any arena. The director of the program stated that she felt some ...

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shutterstock_44443642 There was a time when doctors were doctors. There was a time when young men and women sacrificed the best years of their youth, learning to treat patients and conquer diseases, not to become typists, paper pushers, data-entry clerks, or to have hospitals, insurance companies, and the federal government dictate to us how to practice medicine. There was a time when doctors were ...

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After every mass murder, the question everyone asks is why it happened. How could anyone possibly be so violent, or so evil, or so out of control, or so crazy as to engage in the wholesale and indiscriminate killing of a bunch of people who are usually complete strangers? In some cases, there are longstanding preexisting warning signs: a history of mental illness, substance use, isolation and/or estrangement; the repeated experience ...

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Chinese hospitals are recruiting 1,500 “guardian angels” to protect doctors from violent patient attacks. Patients who are angry about the Chinese health care system, medical expenses, long waiting times, and uncaring doctors have become more violent over the years, with violent attacks occurring every two weeks on average -- according to state media -- which in reality means that it probably occurs a lot more frequently than twice ...

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For the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan … ford). I used to play a game with the med students and housestaff: Let’s estimate how many of our inpatients actually didn’t need hospitalization, had they simply received effective outpatient preventative care. Over the years, our totals were almost never less than 50%. For my ...

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One of my most treasured stories as an ED physician belongs to a lovely couple who valued quality of life. It was a routine day in the ED when an elderly woman rolled through the ambulance doors on a cold, narrow stretcher, unaccompanied by family. She was placed in bed 5, which is where we met. She was frail and her memory was poor. The EMS run sheet reported “change ...

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Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests -- I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family ...

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Q_GVE0837-136-1024x701 I’ve always been a people watcher. Now I get paid to spy on folks. I have to ask detailed, personal questions. Sometimes I even snoop around patients’ homes. In the 1930s nearly half of all patient visits were house calls. Now most patients are rushed through ten-minute office visits. But if I need to know what’s going on with a patient, I ...

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