When I was growing up in the ‘50s and ‘60s, virtually every primary care doctor (pediatrician, internist, GP-there were no FPs) I knew of had his office (women in practice were rare) located in a wing of his home, with the driveway enlarged to accommodate patients.  A new physician in practice would simply hang his name on a shingle in front of the house.  These doctors were paid in cash, ...

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I’m not sure when it happened, but driving into the parking lot that cold winter day, I knew it had. Tears welled in red eyes, snot dripped out of my nose. I felt so alone and lost. My whole life I’d wanted this -- the drive to the hospital and wondering whether I would change a life. But as I sat in my car, engine off, I didn’t want that ...

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An excerpt from Free Refills: A Doctor Confronts His Addiction. It was a frigid winter day in February 2005, when two officers -- one from the state police, one from the Drug Enforcement Agency -- arrived at my office and sat waiting amid the spellbinding view of the neighboring arboretum and ...

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In the last month, I have used the ICD-10 codes Z59.0 (homelessness), Z59.1 (inadequate housing) and Z59.9 (unspecified housing or economic problem) far more than I ever would have imagined. Several patients came into my urban clinic with varied chief complaints, including issues with uncontrolled asthma, chest pain, stress, worsening knee pain and sciatica. However, after listening and asking questions, I quickly realized that all of these initial complaints shared a ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. More than ever before, patients are receiving laboratory test results, with some of their numbers in bold or with “H”s or “L”s next to them. In some cases they’re getting them straight from the lab, in accordance with federal regulations. If not from ...

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1. I applied to medical school so that I could become a doctor and provide care for patients. I care about people. I am eager to be part of the health care community. I believe that most, if not all, physicians feel the same way. Physicians are also human and flawed and fallible. Everyone, including physicians, have off days and make mistakes and run late. What you may not know ...

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It is a common experience to feel that our body has let us down when we get sick. We may feel it is broken or flawed in some way and if only it was better designed we wouldn’t have to suffer illness and disease. Likewise, we tend to consider illness and disease as something bad that has happened to us and which we associate with suffering of some kind, be ...

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Today I have a practical exam; that means doctors are shadowing me. It’s my turn to talk with patients about their diagnoses, and I’ve been looking forward to that part of medicine. It’s my second patient; she’s here for vaginal discharge. I go in, introduce myself and explain my role. I’m still mediocre at documentation, but I’m good at putting patients at ease, so we make small talk. She just moved ...

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Medcomic-Multiple-Sclerosis This Medcomic highlights some of the main features of multiple sclerosis (MS).  Although the exact cause of MS is unknown, the disease is thought to occur as an immune-mediated attack on the central nervous system (CNS). As you can see in the illustration, the white blood cells are attacking the neuron and causing inflammation, demyelination, and axonal degeneration that can manifest through ...

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The other day while having my lunch in the doctor's lounge, I ran into one of the older physicians who works at the hospital. He had a weary look on his face, and so I inquired if he had a tough call night. “Actually, I haven't slept well in a few months,” he quietly responded. It turns out he was being sued by a family who had only seen him once ...

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Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: How to encourage more clinicians in geriatrics and long-term care to use social media? In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?” This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older ...

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On February 3, 2016, many physicians on social media took a moment to celebrate the first ever National Women Physician, timed to coincide with the 195th anniversary of the birthday of pioneer, Dr. Elizabeth Blackwell. I began the day with a Facebook post wishing all my fellow women physician friends and colleagues a happy #nwpd and adding, “May today be the last day someone says to any of us ‘you look ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide. On physical ...

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The first time I cried as a doctor was in residency. I was taking care of a patient who had terminal lung cancer. The first time I met him, his wife was at his bedside. The couple displayed such a positive outlook on life and seemed to have accepted the poor prognosis. He was one of the first cancer patients I took care of. Being a cancer survivor myself, I felt a ...

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Mamas don’t let your babies grow up to be surgeons. Really. Don’t. As the mother of a soon-to-be fellowship-trained surgeon, I know what I’m talking about. Listen to me. Ignore Willie Nelson. You don’t want your babies to be doctors; you want them to be cowboys. Really. Yeah, yeah, I know, your daughter is a whiz at all things mathematical and/or spatial. And your son is a science prodigy. Their eye-hand coordination is legendary ...

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Part of a series. I have advocated in this series of posts on direct primary care in one form or another (i.e., membership, retainer-based, concierge and various other incarnations and conceptions) because it works well for both patients and primary care practitioners. Direct primary care allows the doctor the opportunity to give the type of outstanding care that each of us needs, whether currently healthy or beset with multiple ...

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No matter how early I rise with the intention of getting my workout done before my children wake up, I’m rarely able to do it alone. Most days my 3-year-old daughter climbs out of bed and comes straight down to our home gym and watches me do my workout. Often times she’ll sit quietly in the corner, but sometimes she’ll join in and follow the trainer on my workout DVD and ...

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Like many of you, I have a fairly long commute. Recently, as I was driving and scanning the channels on Sirius, I landed on a talk program hosted by Dr. Laura Schlessinger -- a certified marriage and family counselor (her PhD is in physiology) with many decades of experience, a stack of best-selling advice books, and a very long running radio show. The caller was a young woman with a cheating husband and a ...

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As part of my pediatrics rotation, I recently spent a week taking care of patients at juvenile hall. The patients were physically healthy for the most part; I saw them for screening physicals that they receive while incarcerated. However, these encounters were far more than a typical physical. Instead of focusing on medical issues, we primarily talked about health behaviors and general well-being. It was a rare opportunity to interact with ...

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asco-logo Every month or two I see a patient, usually a man with prostate cancer, who is concerned that if he has intercourse with his spouse, he will give her cancer. The question is asked with sincerity, and I can see the worry in the man’s eyes. His spouse is often equally worried but she often looks embarrassed too, almost as ...

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