In inpatient settings, family physicians frequently care for patients with progressive, incurable conditions that cause severe pain. Interventions aimed at slowing the progress of a disease often add to patients' physical distress; therefore, pharmacologic management of pain is a key component of end-of-life care, as outlined in an article in an issue of American Family Physician. However, as Drs. Timothy Daaleman and Margaret Helton discuss in an accompanying editorial, providing analgesia is ...

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We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few ...

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There are doctors that patients see. And there are the doctors that patients almost never see. Patients see me, an obstetrician, at prenatal visits, in the ultrasound unit, or on the labor floor. But they don’t see all the wise radiologists reviewing their imaging studies, or the educated pathologist assessing whether their biopsy is cancerous. Some of the most important doctors that our patients don’t see are the ones in the ...

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Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me. I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn't get written for her care by the admitting physician. ...

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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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