A 33-year-old woman in Indiana, Purvi Patel, presented to an emergency room with vaginal bleeding and when it was obvious that she had very recently delivered a baby the doctors on call notified the authorities. The body of her 28-week gestation infant was recovered. The pathologist believed the baby had taken a breath so Ms. Patel was with charged with neglect of a dependent. Sometime later the police ...

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She was having excruciating pain in her pelvic area.  I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs.  I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart.  ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain. The emergency room physician had dutifully ...

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7:00 a.m. Lights on.   Coffee, black and a banana. Paperwork.  27 patient visits, 3 emergencies, 35 phone calls.  Lots of computer time. Some laughs and a few tears. Paperwork.  Last family meeting.  Coffee, black.   In between: Thursday. Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range ...

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You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan. I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the ...

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Much is being made of the AMA's recommendation to reimburse doctors for the time they take in having end-of-life discussions with their patients.  The recommendations appear to have a good chance of being covered by Medicare and certainly are a step in the right direction.  But will one conversation and the completed documents really work?  Well, like so many other situations -- it depends. How skilled is the medical provider ...

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Dont forget to feed the doctors and nurses I went to the hospital cafeteria one day last year and experienced an epiphany. It was around 4:30 p.m. and the place was supposed to close at 6:00 p.m. As I entered, the folks inside were covering up the food and putting it all away. "Did you want something, I mean, we can make something for you." "Nope, I guess not," ...

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Even in the 21st century, talking to your doctor about your symptoms matters. This is something I tell my medical students. Talk to your patients. Listen to your patients. Use their story to determine what tests and imaging tests to order, if needed. Don’t get fooled by technology or be in awe of its importance. It is the patient’s experience that matters.  It isn’t the other way around as we ...

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A frustrating patient, and how that affects her physician There’s a patient I don’t like very much. I’ll call her Mrs. X. Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur. Every time she makes an appointment, ...

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So doctors are sick of medicine: What can we do to fix that? Dr. Sandeep Jauhar, a cardiologist, believes with good reason that many physicians have become “like everybody else:  insecure, discontented and anxious about the future.”  In a recent, widely-circulated column in the Wall Street Journal, “Why Doctors Are Sick of Their Profession,” he explains how medicine has become simply a job, not a calling, for many physicians; how their pay has ...

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Actionable items. Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home. I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with ...

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