Peggy was in her early 70s and suffered from a terrible lung disease known as pulmonary hypertension. So bad in fact, that she had a pump infusing a medicine under her skin 24 hours a day to keep the blood supply to her lungs open. Once started, this medicine, treprostinil, was known to improve life in those with pulmonary hypertension. Unfortunately, like all continuous infusion medicines of this type, it ...

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I was jogging one day while on a business trip in LA and collapsed during the run.  Within hours, I was at the hospital at UCLA Medical Center on a gurney headed for a CT scan of my abdominal cavity.  I remember telling the ER physicians that I was a doctor and recommending my own course of action.  As my advice to the ER doctors went largely ignored, I realized, ...

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"Twenty years ago, I helped save a man's life." So begins this New York Times essay by Peter Bach, MD, where he talks about the inadequacy of resource use at the end of life as a policy metric. Now, I am not very fond of policy metrics, as most of you know. So, imagine my surprise when I found myself disagreeing vehemently with Peter's argument. Well, to be fair, I did ...

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Do ear surgeons perform facelifts? Absolutely! And we perform nose surgery and throat surgery, too! A recent article in the New York Times presented a scathing editorial on complications caused by poorly trained surgeons.  However, the implication of the title "Ear surgeons performing facelifts," is misleading and overlooks the fact that a large portion of training in the specialty of ear, nose and throat surgery includes plastic and reconstructive surgery of ...

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I've only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case the heart had stopped beating. Death was clear. Brain death is tougher to cope with, both clinically and psychologically. I imagine it would make anyone want to say, at some point, "Are you sure? Are you really sure? How do you know? How can you be sure?" Some times ...

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Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer.  There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis. ABC News wonders, "How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?" They’re missing the point.  ...

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One of the things I love about family medicine is that I get to care for people of all ages. I almost went into pediatrics, but the time I spend with older adults was too valuable to give up.  Our elders have such great stories and knowledge to impart - it’s an honor to participate in their lives and share their experience. Since I first realized in residency training that Medicare ...

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Cancer has a way of teaching us poignant life lessonsI just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by the passing of Patrick Swayze from pancreatic cancer and Elizabeth Edwards from metastatic breast cancer. There’s a reason I am a surgeon, and not a medical oncologist. Death has this bleak sadness about it, that eternal optimists ...

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The orders came indirectly from the government. Reduce hospital re-admissions. Cut costs. So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me. My task sounded simple. Create a palliative care program at the nursing home. But as I gathered for the first meeting with the administrator, social worker, and clinical staff, I knew there would be ...

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I recently wrote that "diagnosis is job number one."  In sports, there are times when two teams share the number one position.  Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking. In medicine, care and diagnosis share the number one spot, working together toward a common goal:  to promote health.  Some would say that, without care, the diagnosis is worthless.  Certainly, ...

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