I often get referrals from the town's free clinic.  As you would imagine, the patients often have a unique set of problems, coming as they do from the underserved segment of society. One such patient, Julia, was a fiftyish-year-old woman who had recently moved to town from California. She went to the free clinic (not really sure what the original complaint was) and ended up getting a physical exam that revealed ...

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Americans are waking up to the fact that the $170 billion that Medicare spends on the last six months of life is not helping us die well. Instead, the way we die today tends to be protracted, undignified, and painful. Sarah Palin’s “death panel” debacle temporarily stifled all discussion on the subject, but the silence has been broken by dialogue inspired by the Institute of Medicine’s recent report, Dying in ...

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Let's face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience.  The emotions run from jubilation to sheer terror. It is inevitable that some of the people you interact with will leave a lasting impression. In the case of the resident, it is the attending physicians that fulfill  the ...

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“55-year-old man with history of laryngeal carcinoma, status-post radiation therapy, laryngectomy, bilateral neck dissection, with metastases to the lung, status post thoracotomy, currently undergoing chemotherapy who is being admitted for a for first-time seizure. Patient is a transfer from Riker’s Island.”
Prisoners are a common occurrence in Bellevue Hospital. This, however, was my first prisoner-patient. The hyphenation both as I write this now and as it formed as a concept in ...

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About a year ago, there was a great commercial that depicted the slowing of time as a free-falling, but worry-free, James Franco uses his smartphone to chart a safe landing on the billowy awning of a restaurant dozens of stories below.  There probably isn’t a single person who hasn’t, at one point or another, wished she or he could control time in order to navigate a better outcome.  And doctors ...

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Delivering bad news is part of my job, an important part. It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and ...

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Dear patients, First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your ...

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How many times do we start out our day with the best of intentions? It’s probably most days, if you’re at all like me. Even when we’re going through a spell of negativity, we all try to pull it together for the sake of our patients, our staff, our families. A couple weeks ago, I was tempted to throw in the towel. It was one of those days when the last straw was ...

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Forty is the new thirty. Orange is the new black. And failure is the new success. It seems these days that no success story is complete without a failure (or two) along the way: the bankruptcy that gave birth to a successful company; the entrepreneur who lost it all just before hitting the Fortune 500. Entire issues of the Harvard Business Review and the New York Times Magazine have been devoted ...

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shutterstock_162279323 Party Weekend - Joe “King” Carrasco Fight for Your Right (To Party)! - Beastie Boys We Just Wanna Dance - The Flirts My favorite radio station, WHFS, had a ritual every Friday afternoon to start off the weekend, back in the day. DJs Weasel and Bob Here would exchange pleasantries as they exchanged shifts, and would launch the same set of songs at the same ...

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