shutterstock_224970232 I have worked in a lot of hospitals over the past two years. Quite a few of the facilities have been critical access hospitals, which is to say that they are very small, typically having fewer than 25 inpatient beds, and are usually somewhere in the boonies. A number of characteristics allow a hospital to qualify as critical access and receive additional ...

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shutterstock_141783304 As an Air Force family physician and faculty at a family medicine residency, it was my job periodically to lead an inpatient team of young family medicine residents and medical students.  That particular morning seemed like any other -- half a dozen new admissions, total census of a dozen or so, and a few new consults.  And it was my habit to ...

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Money-640x480 I’m a physician entrepreneur. In 1998, I opened my first clinic. My malpractice: $500 per year. Then I tried life as an employed physician. Hated it. So in 2005, I opened my ideal clinic. Best. Job. Ever. My malpractice: $1,230 per year. Want low premiums? Here’s how I did it. A quick tutorial. New malpractice policies mature over five years. So the first ...

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shutterstock_151579694 During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identified with Casey because we were the same age, and I felt empathetic toward her situation. Casey was very sick, a direct result of her risky behavior. She was admitted for infective endocarditis secondary to intravenous opioid abuse. She ...

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Mid-November, and Christmas music is already blaring from speakers camouflaged in silver holiday tinsel. Frank Sinatra’s croons reverberate throughout the barren expanse that is Somerset Mall at 8 a.m. “I’m dreaming of a white Christmas…” It’s raining outside. I begin to laugh and try to explain the apparent irony to my grandmother, but my attempt gets lost in translation. My Chinese is poor. Her English, poorer. ...

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shutterstock_206417596 acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. In the spring of 2009, I represented the American College of Physicians (ACP) at a meeting in Washington of health policy experts discussing payment reform. When I arrived at the cocktail reception the night before the meeting, a ...

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The acronym "MI" has traditionally meant myocardial infarct, or heart attack. Recently it's taken on a new, more salubrious meaning: motivational interviewing. A growing number of docs are practicing this technique, which amounts to listening to patients to help them recognize their internal sources of behavior. Boston's NPR affiliate, WBUR, describes typical MI interventions in which doctors, instead of demanding that patients stop smoking or drinking or overeating, gently ...

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shutterstock_124029454 Jim almost convinced me.  The burning in his chest, after all, could have just been gastroesophageal reflux.  He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums.  I couldn't, however, ignore that it seemed to worsen with activity.  The pain was bothersome enough to drag him into my ...

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Let me be clear. I have spent a career, my adult life, 80 hours a week, 131,000 hours, fighting the dread disease: every method, every drug, every machine, every medical technique, every sinew of my being, to control or cure malignancy. A synopsis of my existence will say, “fought cancer.” Nonetheless, let us take a step back, if just for a moment, and reflect on the idea of saying, “no.” In ...

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When a doctor makes a mistake, it’s rarely out of ignorance.  We usually have the knowledge we need. Instead, most medical mistakes happen because we’re tired, distracted, hurried, or indifferent -- or maybe some combination of those things. Since physicians rarely publicize their personal frazzled-and-frenzied, pooped-out or burned-out quotients, health care consumers shopping for a doctor often consider Board certification as a kind of Good Housekeeping seal of approval. The “board” ...

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