San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off. As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming ...

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How do you motivate and inspire?  How do you create an environment where people are eager or excited about their daily work? This question has created a multi-million dollar industry of motivational speakers, consultants, and higher education learning curriculum.  I have to admit that I’ve been an avid pupil of the movement, focusing on others when the answer is literally staring me in the face each morning while brushing my teeth.  ...

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The American Medical Association (AMA) recently called for a ban on direct-to-consumer (DTC) advertising of prescription drugs and medical devices, arguing that this type of advertising drives the nation's escalating drug bill by creating demand for new, expensive medications that are often no more effective than older ones. Since the first televised prescription drug ad aired in the U.S. in 1983, pharmaceutical companies have spent billions ...

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“I remember how hard it was to be a third-year medical student,” one of my residents once said to me. “You have to appear constantly enthusiastic. You feel continuously judged and evaluated. And worst of all, you know, deep inside, that if you were to get a cold or something and not show up one day, not one bit of the daily workflow would change because as far as pivotal ...

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An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time. In 2011, Shreya Kangovi hired her first two community health workers, or CHWs, at the University of Pennsylvania Health System. Their role was to develop partnerships with low-income hospitalized patients who were at high risk of ...

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When I hung up my white coat for the last time and left the practice of medicine, the term, “physician burnout” was unfamiliar. It wasn’t until I stumbled across research studies many years later, in my work as a freelance writer, that I finally understood the underlying reasons that I needed to walk away. Today, you can’t read about health care without seeing the term. Does the widespread use of ...

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To many, the extent to which Charlie Sheen tried to keep his HIV status from becoming public knowledge came as a surprise -- and suggests that HIV-related stigma and discrimination remains pervasive despite strides that have been made in fighting the disease. Diagnosed nearly four years ago, Sheen reported paying more than $10 million in bribes to keep his HIV status secret. Sheen decided to go public, he told Matt Lauer ...

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I recently recreated a now-famous business school study on a subset of residents in my internal medicine residency program. In the original study, researchers asked students to read a case of the real-life venture capitalist Heidi Roizen, who expertly leveraged an extensive professional network to forward her career.  Half of the students read the original case; half were given a case in which Heidi's name was switched to Howard -- a ...

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Every now and then, more often when on call, I experience what I think it was like to be a physician when I was a boy. I remember the era of the house call. I remember the physician as a part of the community. You saw him around town, school, and at church. You knew his wife and went to school with his kids. I remember that. And I remember the ...

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February 14th, 1990 was not any extraordinary Valentine’s Day here on Earth. Couples dined, candles flickered, hands were held. On a day characterized by love, companionship, and joy, an enormous marvel of human ingenuity named Voyager One was embarking on a solitary trip into the cosmos. Initially launched 13 years previous by NASA to explore the universe, this spacecraft stood alone in the silent void of deep space, six billion ...

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In September 2010, a seasoned pediatric intensive care unit nurse administered an accidental overdose to a critically ill baby, giving ten times the amount of calcium that was prescribed. Five days later, this baby, with an already tenuous heart condition, died. The nurse recognized her mistake immediately, informed her superior, and also told the family and physicians. She was, however, escorted out of the hospital, put on administrative leave, and ...

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I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader.  In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts:  1) I must be getting old; and, 2) This isn’t going to be easy. I came up with the following list of lessons that I’ve learned ...

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Part of a series. We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist. That is, provided the PCP has the time to care for his or her patients with ...

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Her nails were painted. She probably had them done just a couple of days ago. The bright red polish glistened on her perfectly filed fingernails. She had her toes done too. Was she preparing for the holiday season? Had she begun her Christmas shopping yet? Was she making a list of new year's resolutions? It didn't matter anymore. She was lying there. The cold metal table provided the platform for her lifeless, still body. ...

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Imagine you are an ambitious new worker at a powerhouse institution. Your job performance is soaring, but you frankly work like a dog. Your weeks top out at 80 hours, you get maybe a single 24-hour block of time off every 7 days, you work weekends, and you often work up to 30 hours straight in one stint, sleep at work, and eat exclusively from food options in the building. You ...

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The afternoon began like any other day in medical school.  Students arrived at the lecture hall and took their seats.  An individual with long blue-and-white hair and handlebar mustache entered the room wearing oversized fish-print pants, a loose-fitting clown shirt, and a single earing fashioned out of a bent fork.  He casually strolled up to the front, introduced himself as Dr. Patch Adams, and told us that the ...

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Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen -- a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines. Red meat was labeled in the runner-up category ...

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An excerpt from Cure: A Journey into the Science of Mind Over Body. Linda Buonanno hugs me as soon as we meet, and shows me upstairs to her small, first-floor apartment in a housing block just off the freeway in Methuen, Massachusetts. Her living space is tidy but densely packed ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some ...

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A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patient's abdomen. According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure. An insufflator valve had been sterilized and was ...

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