Years ago on Cape Cod, my kids and I stumbled across a man who had spent the day creating a sand sculpture of a mermaid. It was an impressive piece of art. “How long did it take you to make it? ” we asked. While I can’t recall his precise words, the response was something like “25 years and 7 hours.” I’m sure my astute readers will get his point. We are ...

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2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime. My first night in the unit and my first patient’s chart.  Papers spill from the accidentally opened binder ...

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Living in the fine city of Boston, I am fortunate enough to be located right in the middle of a medical hub. A place that’s full of exciting new research, developments, and ideas. Working at the front line of hospital care, also with a keen interest in quality improvement, patient experience, and technology, I frequently attend social and professional healthcare networking events around the city. While doing this, I’ve gotten to ...

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“Get well soon!” That’s a common saying. All of us have heard it. But what if you have an illness that you won’t ever get better from? The most horrible part of having a chronic illness is that it’s forever, or for a very long time. Unless your personal miracle comes, your illness will always be with you. There isn’t an end in sight. There’s just adjusting to the pain, the tiredness, ...

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To my younger self, I remember how excited you were when you finally settled on medicine as the thing that you wanted to do as a career in your junior year of college. I remember all the questions you had about what the process entailed since no one in your family had undertaken this journey before. I even remember some of the doubts you had when you thought about how long ...

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Many recent articles, blogs, and presentations have focused on what American health care lacks and what additional skills health care professionals should adopt to “fix” our “broken” system. Third-party payers and health care organizations tend to promote the need for quality improvement and economic measures, while clinicians grapple with their transition to less-autonomous employees, noting increased job dissatisfaction and conflicts regarding administration and reimbursements. The theme that American health care ...

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A.J. Smith, a pseudonym of course, walked into my office today, unhappily.  Most of her topical medications for acne caused too much irritation.  The ones that didn’t, weren’t working.  The doxycycline caused photosensitivity in the past.  But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared.  As such, that’s what my patient demanded.  There was only one problem.  The degree of her acne didn’t warrant ...

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The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians. WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary.  This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation. Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, ...

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I was home free: in my final year of medical school, with one last rotation to finish. I had matched into a residency in obstetrics. The tsunami of stress that loomed over the past year -- choosing a specialty, interviewing all over the country, waiting for the life-altering but fickle match -- had passed. I knew where I was going and what I was doing. Our end-of-the-year show was fast approaching. ...

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It’s Friday afternoon at 4 p.m., and Mr. Anderson walks into my endoscopy suite as the last patient of the day. He’s a 65-year-old publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late, because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery. In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by ...

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Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day. My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing ...

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As first year came to an end, we were asked to reflect on our experiences thus far. The multitude of tests and memorized facts, anatomy dissections, and patient interactions flooded my mind. Shockingly, it was not the difficulty of the first year of medical school that I will remember the most, rather the jaded comments from physicians and students that attempted to cloud my perspective of medicine. “Medicine is different now. ...

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I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips. It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these ...

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As the health care landscape in America continues to change after the enactment of the Affordable Care Act, we are seeing an even more diverse group of patients seeking care across the nation. As rapidly as these demographics are changing, however, there is still progress to be made in diversity of health care providers who treat these patients. For instance, although 13 percent of Americans are of African descent,
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Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable.  Did you notice a particular word missing?  Yes, I missed the word physician too, because they have been left out of the conversation entirely. Measuring quality health care by ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years. On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and ...

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As an orthopedic sports medicine surgeon newly in practice, I read with interest Gina Kolata’s article "Why ‘Useless’ Surgery Is Still Popular." As a doctor with a research background, I often champion the importance of research and promote a practice rooted in evidence-based medicine. It also came to me as no surprise when my partner and several physician assistants in the practice pointed out the article to me. ...

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“Hello? Hello, Mr. Bertsie. It’s Dr. Robey. I wanted to call you and check on you,” I said into the phone stopping my constant wrestling with papers and resting what was in my hands on my lap. Mr. Bertsie and I were meeting in the equinox. “Oh, hello Doctor,” he said with a little relief, a little surprise, a little delight in his voice. “I’m doing OK. I walked the dog ...

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In July, I found myself needing to step away from social media and news coverage of the recent shootings in Louisiana, Minnesota, and Dallas. Being a psychiatrist has made me sensitive to the toll of pain and anguish that life may bring, even as a bystander. This occurs even more so when I can all too easily imagine myself as a victim of one of these unfortunate events. In the aftermath ...

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I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer. A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis. Unfortunately, his condition deteriorated quickly thereafter, ...

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