We live in a headline/hyperlinked world.  A couple of years back, I learned through happenstance that my most popular blog posts all had catchy titles.  I’m pretty confident that people who read my blog do more than scan the titles, but there is so much information coming at us these days, it’s often difficult to get much beyond the headline.  Another phenomenon of information overload is that we naturally apply heuristics or ...

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A recent article suggested that the use of observation status for a hospitalized veteran was a dishonor to his years of service to our country because observation was going to subject him to higher out of pocket costs. This post created quite a lot of discussion and debate. While I agree with the author and commenters that observation is confusing to all and that there has to be ...

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The family medicine fellow set down her pen and inhaled deeply. “So when is it OK to cry with a patient?” she asked the senior attending across the table, a veteran internist in her mid-60s. About a dozen of us -- fellows, physicians, writers -- sat hunched over a paper- and laptop-strewn table in the fellows’ shared office, talking about a poem: Sharon Olds’ “Death of Marilyn Monroe.” In it, Olds ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is ...

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Like many boys born in the 60s, my heroes were often frontiersmen.  I grew up watching the Daniel Boone television series, with Fess Parker.  (I can hear the theme song in my head as I type.)  I watched the Disney production of Davy Crockett, and had a comic book of the same.  I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy ...

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Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to ...

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Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly ...

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"One of the most prominent definitions describes burnout 'as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'" - Maslach, Jackson & Leiter, 1996 In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout." In it, he wrote about the physical and emotional symptoms of ...

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I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means ...

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At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor. Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data. Leapfrog’s top 98 included 62 urban, 24 rural, and ...

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Opioids, also known as opiates, serve as important prescription medications in medical practice. But within the last decade or so, because of their overuse, misuse and abuse, they’ve also emerged as a leading cause of addiction and death. Sadly and surprisingly, those most instrumental in creating this epidemic -- however unwittingly -- are physicians and the pharmaceutical industry. The question is, how could this crisis have happened? What responsibility should physicians take, ...

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This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump.  The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security. He is looking increasingly likely to be nominated by the Republican Party.  Many, however, ...

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These are the words that inspired me to begin my journey as a medical student blogger. Four years later and  I'm still at it!  The time has flown since I received my acceptance letter to now, only a few weeks away from my graduation.  And as graduation approaches and I make the transition from student to resident, I can't help but ask myself, how am I doing?  How is my first patient really doing? It's a difficult question ...

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My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual. Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a ...

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As a primary care physician at one of the nation’s leading academic medical centers I’m still hanging on. Over my 32 years, I’ve seen how my ability to interact with patients has been diminished by an ever-encroaching health care system. There’s a clock keeping track of how much time a patient’s chart is open. I have less than 15 minutes on average to assess my patient’s symptoms and discuss treatment options, ...

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For years, many physicians have complained about the onerous nature of government-certified electronic medical records. However, thanks to the HITECH Act, the rush to digitize medical records has continued. Due to the impetus provided by the ACA and subsequently by MACRA, the mad rush has progressed into a frenzy of data-collecting and reporting activity, all in the name of value over volume. Recently, two objective reports have surfaced demonstrating the futility of ...

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A friend posted an article on her Facebook page discussing a recent research study out of Sweden showing that people on the autism spectrum have a decreased life expectancy. This friend has a child with autism. Autism coupled with learning disability, according to this study, is associated with the largest decrease in life expectancy. This friend’s child has learning disabilities along with autism. My friend is scared. On top of her worries ...

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Dear health care administrator, I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the ...

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Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the ...

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My last post discussed the wide gulf between health care and the rest of the world in the area of customer service.  To sum up what took over 1,000 words to express: Customer service in health care totally sucks because the system promotes that suckiness and does nothing to penalize docs who make people wait, ignore what they say, rush through visits, and over-charge for their care.  We ...

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