Medical lessons from Robin Williams Dear Robin, You were such an inspiration.  You showed us courage in the face of adversity, making us laugh while your own soul was broken. Even now, at the time of your death, we find ourselves in a recently forgotten place where all people -- regardless of faith, color, or country of origin -- stand united, sending out love to you and your family. You ...

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Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions.  In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting ...

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Nearly every day we read headlines about the serious prescription drug problem in America.  Increasing heroin addictions and deaths from illicit drug use are taking a severe toll on far too many families and communities. While we must feel enormous sadness for the families experiencing these tragedies, we must not overlook the other major health crisis that is often associated with the opioid abuse problem: chronic pain. The chronic pain crisis ...

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I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient.  That seemed self evident and logical.  "Do no harm" was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make "the right" decision for them -- not necessarily including them in the conversation or ...

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A primer on the anesthesia care team modelA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist.  Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician.  Once we get into the discussion, patients are also surprised to learn that ...

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A wise friend who had completed residency told me prior to my starting training that the key to having fun was “never sit down when you get home from work.” Three years out of fellowship and practicing as a psychiatrist in Brooklyn, the words still resonate today.  The residents and medical students that rotate with me marvel at the stories of my full time acting career as a resident performing in ...

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I am so sorry I didn’t make this different for youThe telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before. I hesitated before calling her, recalling her mother’s cancer course. Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy ...

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Question: What do you do when presented with abnormal lab results? Answer: Ask lots of questions. The nursing home just sent over a urinalysis on a patient of Dr. Carlyle. I am covering his practice for a few days. The test showed that an 82-year-old woman had 3+ white blood cells in her urine. “NKDA” was written in the margin, indicating she had no allergies. I sighed internally and called the nursing home. ...

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There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes. In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician? Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha. Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of ...

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OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.”  According to their website, three million patients now have such access, generally online.  Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others. Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary ...

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