In the not-to-distant past, American health care was the gold standard. It offered job satisfaction and autonomy, was financially rewarding and was considered by many to be the most honorable profession. But as we all know, over the last two decades, increasing health care costs and demands and increasing competition for insurance contracts have changed the face of medicine. Metrics ranging from quality and safety (which are needed and were ...

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From a young age, I knew I wanted to be a physician. There were no physicians in my family, but I had interacted frequently with doctors as a child and felt a strong desire to similarly help others as I grew older. To this end, I focused on academics. In choosing a university, I chose the one I felt was academically best, despite being a private school in an expensive city ...

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I am a bioethics researcher who studies physician misconduct. I am also a former gymnast. I haven’t really kept up with gymnastics since I quit when I was 17. With the exception of the most recent Olympic Games, I avoid watching it on TV. The taciturn criticism from the commentators is too much for me to bear. I think, of course, she didn’t stick the landing. She just flew through the ...

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“Daddy, time to wake up! It is morning time!” I open my eyes to our four-year-old daughter at the foot of the bed smiling, her hair meticulously braided. I get up and wake her younger brother from his crib and carry him downstairs. The baby is still sleeping. Soon come shouts of “coffee!” as we enter the kitchen -- they know my routine well. After breakfast, we all get dressed, I ...

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A few weeks ago, I had the opportunity to interview a faculty physician at a large academic medical center. We spoke about burnout in students and faculty in general terms. He was aware of the problem yet did not seem affected himself. I asked him how he managed to avoid burnout. He talked about remembering his purpose in entering medicine -- that the profession is a calling, not just the daily ...

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Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won't be able to handle something. Sometimes I feel afraid of the unknown ...

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And if they can, should they? In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices ...

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Most of you know me -- if you know me at all -- as a pediatrician. But I’m a parent, too, just like you. I have three fantastic girls that I love dearly. Let’s talk. My first daughter was born before I knew anything about medicine. She has taught me more than I could have imagined. I’ve watched as she has grown from a tiny and helpless infant ...

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The return from a vacation weighed on me physically.  This had been a true vacation -- an entire week away from clinic and spent with my family.  I even managed to unplug to the point of only checking email on my phone twice per day -- really! The tension that years ago took up permanent residence in my shoulders had faded away without my noticing, so that when I awoke to ...

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The emergency room is packed. I interject another question to further clarify when exactly Mrs. Smith’s chest pain started, cutting off a story about her daughter -- a tactic I would have found unthinkably rude only years before but has now become a necessary technique. After leaving the room, I try to put in orders, but the electronic medical record resets itself, I’m informed an X-ray won’t upload unless I ...

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