Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew ...

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Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER. You may get lucky, and find yourself ...

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The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated in a ballroom, which shared its building with a bowling alley, in the heart of Harlem. It was particularly warm inside the building, and we were being served hot coffee while ...

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Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do. Why do doctors over order? These same people thought a ...

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On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years. On April 23, 2015, we lost Kevin Dietl to suicide just weeks before he was to graduate medical school. Kevin's parents were so excited to attend their son's graduation. Instead, they attended ...

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“Hey, Doc!” I heard the patient say as I blazed by bed A. Bed A is the "door" bed. My patient was in bed B, the "window" bed. I had just met him; it was a new inpatient consult. For all the rules and regulations surrounding patient confidentiality, the curtains between beds do little to protect privacy since inevitably there will be audible conversations about symptoms, diagnosis, and management between patients and ...

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I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician "Dr. Barkus Yellby."  Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated ...

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There was a morning where I felt like the smallest human being on earth. It was a morning spent in the OR, where it seemed like I could do nothing right. I placed the Foley incorrectly on my first attempt, and then ended up removing it incorrectly as well. I nonchalantly brushed past the robot we were using for the case, which was already draped and prepped, and whose sterility I ...

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When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of strangers. She came to me hoping I could improve her appearance. The abnormal connection between the arterial and venous halves of her circulatory system caused her cheek, jaw, and neck to ...

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"Do you need help getting undressed?" Jon asks from the doorway of our bedroom, one hand holding his BlackBerry, the other tucked into the front pocket of his baggy jeans. His head is slightly tilted, his eyebrows arched, highlighting his forehead wrinkles. His phone vibrates, drawing his eyes from me to the incoming message. I wait. Jon reads, ponders and then looks up, half-absorbed in what he's just read, and registers that ...

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The U.S. health care system is the world's top in health care spending per capita, but in terms of performance, we're dead last among developed countries. As a young physician embarking on a career in this landscape, it's glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among ...

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I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed ...

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asco-logo I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes always seemed to smile as broadly as she did. “Nice to see you, Doc!” she would say. I ...

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“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s blind.” Puzzled, I looked at my list of patients and, not sure whether I should write “violent” by this patient’s name, I decided instead to write “blind.” I paused. The ...

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We have a problem in our clinic. Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled. There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders. Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty. That ...

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Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it? A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a bill calling for more education, presumably physicians as a prime target. We’ve actually been down this road before, but possibly not how you think. The politicians and pundits used to complain ...

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The United Kingdom’s National Health Service has been facing something of a crisis over the last several months. For those of you unfamiliar with what’s been happening (the issue hasn’t really gained any media traction here in the U.S.), a majority of the country’s 55,000 junior doctors have been holding regular strikes. In the U.K., the way in which doctors train is very different from the U.S., with often over ...

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When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be ...

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It was Saturday evening, and Audrey G lay awkwardly on an emergency department stretcher in search of a comfortable position. She suffered from chronic hip pain, the unfortunate and unexpected effect of pelvic surgery. But her real chief complaint involved her drug-abusing husband, who that morning stole her recently filled bottle of oxycodone, an opioid pain medicine. Her story included the surgeon who doubted her pain and a year of ...

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As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world.  I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or ...

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