shutterstock_139886491 1.  Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse. Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to ...

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shutterstock_153098018 With much hype and fanfare, the independent investigative journalism outfit, ProPublica recently released their Surgeon Scorecard, assessing individual specialist surgeons who perform elective knee and hip replacements, spinal surgery, prostate surgery, and gallbladder removal surgery. I had blogged about the impending release.  My trepidation about the idea of a non-medical, non-scientific organization analyzing complex surgical data concerned issues such as ...

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shutterstock_154024799 Part of a series. I put down my blogging pen last fall to focus on two things. One was completing a new book: Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor. The second was preparing to move to a retirement community. We live in a pleasant neighborhood with nice ...

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shutterstock_133154222 Before I was a doctor, I was a dad. My oldest daughter was two years old when I started medical school, so I did a little bit of parenting without the benefit of any medical knowledge at all. I remember her 2-month visit well. It was one of the few visits that I was able to make, and my baby girl ...

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shutterstock_215416810 One of the ghosts in every exam room is the institution that pays many private doctors over ten million dollars, the authority that determines that you can order a BNP (brain natriuretic peptide) to look for heart failure in patients with shortness of breath but not when they have leg edema. You know who I’m talking about: Medicare. Medicare is not only ...

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shutterstock_166576619 As I have said before, when done correctly,  doctoring is an act of love. It is founded on the most basic of human interactions, intimacy.  Patients open their doors and closets revealing a treasure trove of brutal humanity.  Physicians dedicate themselves to healing, to upholding a sacred covenant born of tears and blood.  It is a partnership, a carefully rehearsed ...

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shutterstock_100173191 Consider, for a moment, that you are a new physician. A patient, who is a lifelong smoker, comes to your clinic complaining of shortness of breath, and after conducting several tests you diagnose him with chronic obstructive pulmonary disease (COPD). Relying on your training, you prescribe medications, arrange for follow-up visits and describe activities that can help him better manage his breathing ...

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I love that patients have so many more tools to learn about their health. Between Google, TV, magazines and the thousand-word warning that comes with every prescription, it’s almost like you don’t need a doctor. This is especially true if you do the two most important things for your health: eat less and exercise more. Except it’s not really that simple. There’s a reason it takes at least seven years to ...

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Recently, I wrote a piece on developing the state of connection within a medical family. In it, I highlighted the fact that everyone has a role in growing this connection and that everyone’s time, energy and effort is important. I also touched on the importance of parents presenting a unified front as the parental team. This piece focuses more specifically on developing that unified team approach. It can be ...

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shutterstock_250145857 I need a new stethoscope. I have to wrap my fingers around the fissures in the tubing to make this one work. For me, these days, listening to the patient's chest is more a ritual than a means of diagnosis. After twenty years as a primary-care internist, I now work full-time in hospice and palliative care. I spend more time listening to ...

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