We spend a lot of time in medicine in education. Pursuing medicine as a career requires embracing learning for a lifetime, because there is always something new, always something different, new approaches, new medications, new discoveries -- we want what's best for our patients, and you can't deliver on that promise unless you know what's out there. As a consequence, we spend time trying to organize information, categorize it, study it, ...

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Compared to most others in society, physicians endorse, and are held to, higher ethical standards. (To illustrate, here are ethical codes from the AMA and the World Medical Association.) High standards apply to professionals in other fields as well, especially fiduciaries such as attorneys, accountants, school teachers, and judges. But standards of medical ethics may be among the most stringent. We put patient welfare first, and anything that interferes ...

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1408738840000-Dr-Oz-Headshot-2 If I could invite four people for dinner, alive or dead, they would be Mark Twain, William Shackleton, Christopher Hitchens and Homer Simpson (Bart’s dad). If Mehmet Oz turned up with a bag of Garcinia cambogia, I would excuse myself. Few things drive me to the abyss more reliably than the banality of status updates on Facebook and the monotony of health ...

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shutterstock_148398755 We both agreed that it was unfortunate. I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After ...

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Although the time of year when everyone has their list of tax questions has just passed, tax questions are appropriate all year. It’s best to be prepared at tax preparation time, so much less stress is created. Tax time can be especially stressful for younger taxpayers who are going through life changes, or earning substantially higher income for the first time. Young physician families are an excellent example of this type ...

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My 85-year-old patient was brought in from home. She was cachectic, contracted, minimally responsive to questions, covered in multiple decubitus ulcers on both hips, both knees, both shoulders, and her sacrum. She had polymicrobial sepsis-bacteremic with two different organisms. She was, in fact, dying. Despite her profoundly debilitated condition, her son, who cared for her at home wanted “everything” done. So she was placed on IV fluids, antibiotics, received an ...

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shutterstock_245121460 A while ago, I wrote about “The secret lives of doctors.” The post must have struck a nerve because it went viral, maybe because it helped patients to realize that doctors are human. We doctors can’t really know how human we are until we become a patient. That happened to me recently. And it wasn’t pretty. You need to know the ...

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Somewhere along the way I learned to believe that if a declaration is written down on physical paper and signed, it carries with it an almost magical certainty of follow-through: it can be framed, cited, stored in a safe, and, if need be, brandished in a court of law. This is an interesting idea in the realm of advance directives. Well-intentioned advance directives The goal of an advance directive is to protect ...

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Fire-Doctor-640x399 Not all relationships work out. My prescription: If a relationship isn’t working, end it. Now. Recently an insurance plan told me they were sending a nurse to my office for a chart review that would take 3 hours. After 24 years of education, state licensure, board certification, and over 50 hours of continuing medical education each year, I’m not trusted to provide Pap ...

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shutterstock_263483609 Emergency medicine physicians: Could these be your cases?

  • A 35-year-old presents with shortness of breath and numbness to the legs. CXR and EKG are normal. She is discharged to see her doctor in two days, but is found dead at home. Autopsy reveals a dissecting aortic aneurysm.
  • A 15-month-old is triaged to fast track and seen by a physician assistant for fever, lethargy, ...

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