At the graveside, they still talk about judgment, intelligence, and the wisdom that is the practice of medicine. Deans and health care leaders wax poetic as they tell stories of great cures to lift in memoriam remarkable healers. Yet, though we bow to Hippocrates, Osler, and Salk, the time has come to mark a revolution in human history: The art of medicine is dead. It is not that doctors have fallen from ...

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You've been swindled. At least that's the conclusion I've come to. It wasn't the hucksters or the snake oil salesman. It wasn't big business, big medicine, or some greedy hospital administrator. It was most likely pharma with a large dose of helping from your doctor. Plain and simple. I've learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into doctor ...

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Recently I found myself sitting in my car in the parking lot of my clinic, unable to will myself to open the door. I didn’t want to head into the clinic that morning. Instead, I was filled with despair; overwhelmed with the events of the world. How can I do it? I thought. How can I walk in there and summon the energy to see my patients? An even worse thought: Why should ...

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I wish I knew who coined the term “DRexit” so I could send flowers or a bottle of whiskey as a thank you gift. There couldn’t be a more perfect term to describe the growing exodus of physicians from our beloved profession, which is turning into a morass of computer data entry and meaningless regulations thought up by people who never touch a patient. The one bright note on the horizon ...

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When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had general paralysis of the insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the poll tax. A little bit of medical knowledge ...

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Thinking outside the box is a somewhat cliché way to illustrate thinking beyond the norm and imagining what “could be” with an innovative mindset. This imagery of being stuck in a box rings true for many physicians, given how many of us are quite literally surrounded by the four white walls of an exam room most of our lives. Physicians work hard to treat each patient individually, but this feeling of ...

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The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for ...

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A few days ago, just after dawn, while I was out walking the dog, our home phone rang and my wife answered it. She's used to my pager, cell phone, and home phone ringing at all hours, and so she was not all that surprised when an unidentified voice said,"We're looking for the methadone dose for patient John Q. Smith." She told him I was out of the house at the moment, ...

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After life itself, it is said that God’s great gift is vision. 80 percent of what we learn is through vision. Babies are not born with perfect vision. They develop vision over time. A child who never developed good vision does not know what normal vision is -- he or she assumes that however they see is normal. There is nothing like the overwhelming emotion I have each time I ...

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I cried this morning. It wasn’t because of the patient who coded with a wide-complex tachycardia and died in front of me, and it wasn’t because of the patient who tried to spit on me for not giving her a prescription for narcotics. Nor was it my intoxicated 2 a.m. bar fight patient yelling at my other patients, including one whom I’d recently diagnosed with metastatic cancer. It was because ...

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