It is frustrating for patients to have unanswered questions, and it is equally frustrating for doctors to not have answers to their questions. In the past month, I have cared for three patients who have stood out to me because they have all presented under personally dire situations. “I have had crushing 10/10 chest pain since this morning,” Ms. A tells me at the urgent episodic appointment she scheduled in my ...

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I remembered staring at the computer screen with the radiologist hoping that by staring at the images, they would change in some way. It did not seem fair that a nice lady that I was evaluating in the emergency room would be consigned to such tragic images. I was rotating through the emergency room during my second year of residency, and one of the patients had come in just for ...

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It was Thanksgiving morning. My wife was standing in the living room when she received a text message from her father. Her face went pale, and her expression turned to one of anger and disbelief. She cursed. She cried. Her mother had complained of chest pain and stroke-like symptoms and was being rushed to the hospital by ambulance. Many hours went by with few answers and endless speculation. We had moved ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a routine examination. He has no symptoms. Medical history is significant for a bicuspid aortic valve. He is not taking any medications. On physical examination, he is afebrile, blood pressure is 130/70 mm Hg, pulse rate is 56/min, and respiration rate is 15/min. Cardiac examination reveals ...

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Acute kidney injury (AKI) is hard. Things that seem like they should work often don't. Just ask Perry Wilson. And even the most predictable cases of AKI are resistant to intervention. Look at bypass surgery. We know days in advance the time and place the AKI will occur and despite that foreknowledge, like Cassandra, we are powerless to prevent the AKI. Same with contrast administration (or not). Same ...

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What an upset, right?  Your voices were heard, loud and clear.  The current system wasn’t working for you, and you won a major paradigm shift.  The insulting irony of the word "progress" hidden in "progressive agenda" wasn’t lost on you.  You looked around your respective communities and what you saw sure didn’t seem like progress.  Employment opportunities were scarce, your health insurance costs had risen, and your infrastructure had eroded.  ...

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Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious. As an interventional electrophysiologist, I would meet ...

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A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in ...

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Imagine my surprise and delight when I saw my dentist this week for a check-up and found the electronic health record (EHR) to be both informative and patient friendly. As I sat in the dental chair, the large monitor screen was swung over in front of me, and my dentist was at my side going over it. The monitor was not a barrier; it was part of my exam. The ...

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So, have you talked to your teenage daughter about sex? Have you really talked to her about sex? I’m not talking about the superficial birds and the bees conversation; I’m talking about using words like vagina, penis, and condom. Yes, those words! As an obstetrician-gynecologist and a mother of girls, I know the challenges that our daughters face as they navigate their teenage years. I know how critical it is to have real ...

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The wrong body was cremated by the county coroner’s office in Los Angeles. Jorge Hernandez died of an overdose, and the body of another Jorge Hernandez, an indigent patient, scheduled for cremation, was also present in the morgue. The distraught family of overdose victim Jorge Hernandez had planned a funeral with a viewing and were shocked when they were told his body had been cremated by mistake because a morgue attendant ...

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When I was heading to a retreat held by the physician who started the ideal medical care movement, Dr. Pamela Wible, I expected an orderly and structured program on how to improve the current culture of medicine. I knew, with about 40 physicians and 10 other medical students, there would be a lot of Type A personalities since that’s typically the sort of people that go into medicine. While I ...

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A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit. His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was declared normal by the radiologist. We talked some more about his anxiety and poor sleeping habits. We talked about his late shift at work, and we talked about his late gaming habits ...

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I’m just coming out of two years of sleep deprivation. Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years. This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think ...

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  Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada. Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress. I’m often asked by senior government officials to help harmonize IT strategy at the country level. That — I can do. I frequently say that health care IT issues are the same all over the world. Here are a few ...

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As a clinical student, I’ve been a part of dozens of outpatient clinic visits, but several days ago, I witnessed a clinic visit much unlike the others. For one, our patient arrived not for a 20-minute appointment, but for a three-hour one. As a hemophiliac, this patient came to Stanford once a year, for a comprehensive, coordinated patient care visit, where she saw not only her hematologist but also her social ...

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"If you do not cooperate, doctor, we will have no choice but to label you as being 'disruptive' and take whatever steps are necessary to remedy the situation." What physician does not dread hearing these words? Over the past several years, the term "disruptive" has been increasingly used to characterize and intimidate a physician who is perceived as not being a "team player." With hospitals increasing the difficulty in navigating a ...

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Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room. The man who felt bad all over had a bilirubin twice the upper ...

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We as humans start learning new things since we are born and continue learning until the last breath we take on this earth. We learn lessons that are essential to our lives such as walking and talking, all the way to life lessons that we learn when we face death. I learned a lot through my lifetime; as a child, as a student, as a citizen,  and I continue to ...

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When patients and their families seek hospice care, they are thinking about how they will die. They want to be without pain, shortness of breath, loneliness and, above all, fear. They want to end their lives with those they love, in a place they know, with respect and support. They want control. They want dignity. We all know this, and try to provide it as friends, family and caregivers. Nonetheless, ...

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