A recent issue of the Journal of the American Medical Association (JAMA) reads like an expose. Well, at least three of the research articles do. So exciting! I don't want medicine — my field — to be ethically unsavory, but it is sometimes. It makes me proud to see that it polices itself and that such information is published in a high profile journal. The first article ...

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My colleague, Dr. L.T. Kim, was off this week and I covered for him. On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons. I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency ...

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I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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The boom in telemedicine is here, and understandably so.  The “consumer” is in control now, and they sure don’t want to be “patient” anymore.  When Americans want care, they want it cheap, and they want it now.   Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago.  What savvy health care administrator doesn’t see numbers like that and get dollar signs in ...

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It's Match Day.  Standing with my medical school class in the lobby of our medical education center, there is a palpable energy. It had been a long journey. After reluctantly leaving CA for NY I had finally completed four grueling years. The entire time I was laser focused on doing well enough to make it back to California. The four years came and went in a flash, and without hesitation, ...

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I was raised in a family that hates taxes. Not hates taxes as in, “Gosh, it’s too bad such a high percentage of my paycheck goes to the government.” More like: “How dare the government steal my hard-earned money and give it to undeserving moochers?” (Is there such a thing as a deserving moocher? Sorry, I digress.) The origins of this anti-tax sentiment are deeply ideological, steeped in a frothy mix ...

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Did you know that several Caribbean medical schools provide postgraduate premed courses so students can complete their science requirements? At least one school’s nearly year-long premed curriculum includes 8 hours per day of classroom work, rudimentary general chemistry and organic labs, and a physics lab with 40-year-old equipment. The fee is more than $30,000 cash, no loans. That's a lot to pay for courses that are not accredited and credits ...

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In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life. Dear Pamela, I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been ...

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I know of only two people who, upon starting medical school, knew that they wanted to become psychiatrists. (How did they know what they wanted to do eight years before they did it?) They both achieved their professional goals: One created a community clinic for people with severe psychiatric illnesses. The other became an addiction psychiatrist and now oversees an entire substance use disorder program for a health care organization. I ...

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Health care costs are out-of-control, and many patients can no longer afford medical treatment. The system is broken, but no real fixes are visible on the horizon. Sure, politicians debate the road health care should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the ...

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This week, a resident asked, “What do you say to suicidal physicians?” 1. I don’t say anything. I listen without judgment. Our culture doesn’t support physicians asking for help — or revealing their suffering. As a result, physicians fear sharing suicidal thoughts with friends and family because we’re the ones that others rely on for help. Physicians fear speaking to their program directors or employers because of professional retaliation and loss ...

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When I was a third-year medical student, I was a victim of sexual harassment. I had a patient (I no longer remember his name, so let's call him Mr. X) who was in his eighties and I had to do a rectal exam on him. I had been on the team taking care of Mr. X for a while, and I was fine doing the rectal exam and checking for blood ...

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We do many things in medicine to patients that are either not helpful or have the potential to harm. If you take the long view of medical history, this should not be surprising. After all less than a century ago, physicians were still giving toxic mercury compounds to people in the form of calomel. And a century before that, physicians were bleeding people because they thought that was a good ...

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Physicians are not robots. The health care system (and the corporate world in general) turns idealistic students into jaded and cynical professionals. They become small pieces in a profit-obsessed machine. They count down the days until retirement. We have to beat this system. And to do that, we must protect at all costs our humanity and creativity. We have to challenge the notion of how a doctor “should” be by embracing ...

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I was very saddened to learn this past week of another physician who died by suicide.  This, the untimely death of a young and brilliant mother of two, is a horrifying tragedy. I do not write this to pretend I know anything about this recent tragedy.  I write this as a sort of case report on myself.  I was an at risk physician at one point. I’ll start where the problems most ...

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Two doctors I work with were recently asked to testify in court. I knew it was a case involving domestic violence and I knew I wanted to see what it was like to testify: One day I’d like to work with families in the foster care system, and that will likely mean having to testify in court. So I asked my clerkship director, and with her support, the clerkship coordinator ...

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When I first met Jason, I was a third-year medical student halfway through my psychiatry rotation, and he was a newly admitted patient halfway through a nasty comedown from crystal meth. He sat slumped in his chair scowling with his face hidden by a baseball cap and black hooded sweatshirt and growling responses to my interview questions. "Why do I have to do this? I hate this crap. I've answered these bullshit ...

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Dr. Tom Price may become the first medical doctor to lead the U.S. Department of Health and Human Services in 24 years. One might think that having completed medical school and practiced orthopedic surgery before entering politics might give him some extra insight into what works and what doesn't in medicine. But judging by a letter to then-HHS Secretary Kathleen Sebelius that he signed in 2011 objecting to the ...

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Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room: Back in the good old days, medicine was what we liked to call "fun." Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and ...

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