Even if no life was saved, an ER physician makes a difference I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? I look ...

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Physician goes first: A way to not interrupt patients Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or ...

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Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. A slender, middle aged man, ...

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What a messy house has to do with medicine today I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time. I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of ...

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Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75: An argument that society and families -- and you -- will be better off if nature takes its course swiftly and promptly."  As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest -- and that it ...

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A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system ...

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It didn’t seem like my college-age patient Quincy had any idea what was in store when I entered the exam room. “Hi Dr. Rifkin,” he said with a warm smile as I sat next to him. Quincy (not his real name) had been my pediatric patient for years. I didn’t delay. “Hi Quincy. I’m afraid I have some terrible news. Your lab work came back -- you’re HIV-positive.” His head went back slightly. ...

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(Dis)comfort measures Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that's more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now ...

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When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression. As I opened the exam room door that early July day, I ...

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The attitude when it comes to treating chronic pain Here is the attitude of ER physicians: "Here are a few pills to hold you out for one or two days. Follow up with your PCP -- he or she should be managing your chronic pain -- not me. Now get out of my ER!" Here is the attitude of PCPs: "I simply don't have the time or expertise to manage chronic ...

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