As a general internist who has been on the front lines of adult primary care for over twenty-five years, it is clear to me that we are living witnesses to a major and rapid transformation in medical care delivery. When Paul Starr published The Social Transformation of American Medicine in 1982, his work covered gradual changes over a 200 year period. We now live in a fast paced world where ...

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Like a lot of people, I get pretty numbed to gun violence on television. I stopped watching the local news because all they seem to show is news about shootings. The general public’s perception about gun violence is that it’s always somebody else, that the person who was shot had somehow been involved in crime. The numbness we feel to gun violence often ends for most of us when things ...

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Do you think that physicians’ advice should be based on their patients’ best interests? How about lawyers? Plumbers? Financial brokers? An advisor who has what is termed a fiduciary duty is required to use the best interest standard with his client. For example, an attorney is prohibited from recommending that his client proceed to trial, which would be beneficial financially to the lawyer, if the attorney believes that a settlement serves ...

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Humans are social creatures who naturally evaluate where they stand in relation to those around them. I have no idea how this evaluation process evolved, but at some point we noticed that some cavemen brought more food to the cave than others. The idea was born that some people are better hunters than others. We’ve been trying to decide who is “better” ever since. The origin of the word "test" comes ...

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They say that there may be children, born now, who could live to be 1,000 years old. Can you fathom that? Some humans could continue to live for what would be well more than ten current lifetimes. We aren’t there yet. But this isn’t so far out of the possible. Some medical researchers are already talking about resuscitating those who die up to five hours after death. It involves special ...

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“I need a doctor in here!” As I walk into the resuscitation room in the emergency department (ED), I see Mr. G, a cachectic elderly gentleman barely holding onto his breath. After a rapid assessment, it is clear that he is tiring and cannot maintain breathing on his own for much longer. “We need to secure his airway” -- with my command, the resident applies an oxygen mask, cracks open the ...

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shutterstock_210331261 It's metoprolol. m-e-t-o-p-r-o-l-o-l The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering. I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal ...

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Bleeding is upsetting. At least, that's what I've been told. I mean, I have noticed that many people have visceral reactions to the sight of bleeding, or even just blood. People who pursue a career in surgery generally do not have this kind of reaction, and I find it interesting that it can distress some individuals while others are not at all bothered by it. This might lead you to assume ...

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At the wake, when the kids kept running around, disturbing the disturbed, their mother, or maybe their aunt, or maybe their neighbor, shooed them to the basement. Adult quiet and proper mourning returned. However, I noticed that Mary, eight years old, or so, stayed upstairs. For a while, I watched her, carrying food, clearing plates, even answering the front door. A petite, hard working, hostess. I wondered why. “Mary,” I said, ...

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As a primary care provider practicing in the safety net, I work with incredibly diverse patients with chronic illness. My patients have a wide range of beliefs and preferences about how to best manage their health. I believe their varied perspectives, if more widely shared, could meaningfully improve health care. I also do research on health information technology, and in that sphere I have listened to talks and spoken with many ...

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