I hate being told what to do.  I will scratch and claw when ordered around.  It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.” This is a problem since, as an anesthesiologist, I get told what to do all the time.  My kids order me around all the time.  When I was a nurse I used to bristle at the term ...

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As we grapple with provider shortages, the surge in chronic illness and the quality to price (QPR as they say in the wine business) challenge in US healthcare delivery, it’s hard to imagine a future that does not include some sort of guideline or algorithm-driven care.  As providers take on more financial risk, one common strategy involves team-based care, and the attendant increase in decision-making and care delivery by non-physician ...

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If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick? It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place ...

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JAMA_beforeafter1a Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers ...

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Lawyers are hardworking people. That's for sure. Take this lawyer from Ohio who billed long hours for court-appointed cases. For instance, he billed for 21, 21.5, 23 and 29 hours of work for 4 different days. His lawyer said he did the work but was simply a poor record keeper. Right. Not to be outdone, a lawyer from Iowa billed for more than 24 hours of work in a day on 80 ...

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Have you ever taken note of how much you or a colleague says “I” versus other pronouns?  The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader.  Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization ...

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Pinel, the father of modern psychiatry, is famous for liberating his patients from their chains. But he did a whole lot more. Pinel spent long hours listening attentively to each patient's life story so that he could correlate their life experiences with the onset and course of symptoms. Pinel got to know his patients well enough to like them as people. When given the choice of joining Napoleon as personal physician ...

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Thirty three years ago my husband and I went to Jamaica for a belated honeymoon.  We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training.  Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet ...

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Doctors are burned out and they don’t enjoy their job as much as they used to.  But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed.  There are issues that doctors rarely face: unemployment, inability to pay their rent and food with their paycheck, and lack of health insurance. These benefits ...

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An excerpt from ASSUME THE PHYSICIAN: Modern Medicine's "Catch-22". I bled. With great pride, I skipped the obligatory required mandatory training session on "diversity awareness." I skipped both the primary session and the make up session. The session, and its mandatory nature, had been carefully announced every day for weeks. The ...

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