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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Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients ...

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I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my physician satisfaction system. It is arranged in no particular order. In every physician break room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever ...

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I recently wrote about inter-professional hostility in health care.  I thought I would share some of the inspiration for that post here.   Is there really an escalation of scope of practice conflicts and a downward spiral of disrespect, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder to me. In ...

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I donated blood today. I'm one of those people who doesn't shudder at the thought of needles piercing my skin, or get queasy as I watch the blood drain from my vein into the collection bag. It's no big deal. I eat the cookies and drink the juice afterward, and I kind of enjoy talking with the elderly volunteers. I think I'm lucky. I know so many people who are sickened ...

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"It was a dark and stormy night." My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from drop-down lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software, in general, and Microsoft Word in particular, magically removed the ...

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Last year, I visited my brother in Rhode Island at Johnson & Wales University. We took a culinary school class together learning about the fundamentals of Italian and German cuisine. What were two medical students doing in culinary school? As a fourth-year medical student, I learn the science and art of caring for the body and mind. Unfortunately, the majority of patients are plagued by ailments secondary to chronic preventable diseases ...

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The daughter of the patient walked out of the room livid.  She was convinced that the nurse had no business taking care of patients.  She seethed as she recounted all the supposed injuries and mistakes that had occurred.  I took a deep breath and paused for a moment, trying to collect my thoughts. The daughter didn't know that I had watched this same nurse successfully perform CPR on a man the ...

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I walk into the exam room on a Friday afternoon to find a 16-year-old female who is coming in to see me for a sport physical. On paper, everything looks great: Her vital signs are on point, she’s a straight A student, vaccines are up to date, she eats healthy and exercises regularly, Mom and Dad are still happily married and she’s not dating an abusive senior who is pressuring her into ...

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Today, I talked at length with that lady whose husband has Creutzfeldt–Jakob disease (CJD). That patient -- the one with arbitrary myoclonic jerks, always naked and uncovered by blankets due to uncontrolled flailing, his penis and Foley catheter exposed. That one with overgrown mycotic toenails and eyes that are always only half-open, his gaze drifting everywhere. He was until now just a patient for me -- the CJD patient. Yet today ...

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Dear Santa, I’ve been a very good doctor all year. I have checked all my boxes and aced all my meaningful use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. In December, I concluded a 13-year term on the board of directors of the Rhode Island Quality Institute (RIQI). RIQI was formed in 2001 to “to significantly improve the quality, safety, and value of health care in Rhode Island.” For much of its ...

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recent study of health care organizations showed that most are not prepared to deliver standardized longitudinal care across multiple provider systems. Shared care plans will be the centerpiece of coordinated care delivery, incentivized by the move from fee-for-service to value-based care. In 2015, Medicare unveiled its plan to transition to quality-based payments via the Merit-Based Incentive Payment System (MIPS), which will sunset and subsume earlier quality-encouraging programs, ...

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After having read the article by Marjorie Stiegler, MD entitled "Stop the hostility among health care professionals," I wanted to talk briefly about a group that was not mentioned, but needs to have a voice speak out for them. The EMTs and paramedics that serve this country as paid professionals and volunteers in ambulance services and fire departments all over this nation. Yet, I sometimes find that EMTs and ...

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