I do not know about you, but I get confused about the Heisenberg uncertainty principle.  Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement.  However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits.  If you measure one thing, such ...

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Today was (almost) the last straw. If you've read this column before, you've listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care. This one today takes the cake. Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, ...

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The American hospital as we know it is in peril I appreciate the need for physicians and others to sleep.  I’ve spent a great deal of my career awake in the wee hours.  In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians.  But I fear we’re all wearing a little thin.  Because the emergency room has become ...

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Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death. Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. ...

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Mr. B shook my hand as the paramedics got the stretcher ready to send him to a nursing home. His firm grip punctuated the end of a long hospitalization, which had been characterized by several decisions to leave the hospital against medical advice into extremely unsafe situations, leading into complex capacity evaluation decisions. It was a pleasure to take care of you, I told him. He smirked back at me and ...

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She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding. People ...

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Direct primary care: Setting the record straight Since starting a direct primary care (DPC) practice nearly three years ago, I've become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it's difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice. Two common concerns about DPC have emerged during my conversations with fellow ...

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She died thirsty! Ice chips matter when it comes to patient satisfaction. “My wife died uncomfortable and alone. She died thirsty!” The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to ...

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Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care -- some of it mine -- being foisted on patients. At one point in my career, I would ...

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I keep six honest serving-men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. - Rudyard Kipling Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done. What else could explain why IT people tell doctors what “workflows” ...

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