Being a physician always has been a busy job. This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and ...

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shutterstock_81843283 Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites. 1. The "Q" word. "Quiet." it's truly the kiss of death. The "S" word, "slow," carries the same jinx. Usually some newbie nurse or clerk who is ...

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My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart!  A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be. In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just ...

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When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism. For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me "medical home" was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary ...

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It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide. An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients. The author summarizes a ...

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Ethyl alcohol kills large numbers of Americans every day (about 200), almost all legally. Tobacco kills large numbers of Americans every day (about 1,200), almost all legally. Americans also use many illegal psychoactive drugs and some of these also kill, but the numbers are much smaller. We don't know what the effect on American mortality figures would be if these illegal psychoactive drugs were legalized or decriminalized, but it is a topic ...

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I got the call from the ER because I was the "no-doc" surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don't have their own doctors include more than those down on their luck; ...

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One of the most popular Simpsons episodes ever - MoneyBART - succinctly describes the struggle between intuitive and algorithmic decision making in physical therapy. This struggle, catapulted to prominence in 2002 with the publication of Flynn's manipulation rule, is not unique to physical therapists. Physicians, too, resist the influence of decision rules and adhere poorly to clinical practice guidelines. Physical therapists share some commonalities with physicians in that we overestimate our ...

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Many healthcare organizations are contemplating making dramatic changes in the way they do business and treat patients.  Some of these are driven by the recently passed Accountable Care Act and the Tarp Bill.  They are planning on adopting electronic medical records, becoming Accountable Care Organizations or becoming Patient-Centered Medical homes. Unfortunately, like many businesses, they will undergo a lot of stress and loss of resources in time and money in making ...

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In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really ...

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