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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When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work? The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the ...

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The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways. So what it is ...

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As emergency physicians, we write prescriptions for patients that we discharge home for all manner of presenting complaints. I used to believe that the overwhelming majority of these prescriptions would be filled by the patient after discharge. It turns out I was wrong. Research estimates that patients discharged from emergency departments (EDs) fail to pick up their high urgency prescriptions, like antibiotics, nearly 35 percent of the time. This is problematic ...

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Almost two years ago I went to the funeral of a medical school classmate.  A little more than three weeks before he had jumped from a parking garage after finishing his clinic.  He had a loving wife and three young children. He had the respect of his colleagues and the love of his patients. There was nothing out of the ordinary in his financial or personal life. It didn’t make ...

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Sedated by Oxycodone, Ted slept despite the rhythmic ruckus of his breathing machine. He never felt quite rested in the hospital. While awake, his gaze often lingered on a snapshot that captured him in the past: full of laughter and radiant joy with his little granddaughter, Tara. The grandfather in the photo -- muscular, mischievous -- barely resembled the emaciated elder in the bed who silently mouthed short answers to ...

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A few years ago, the hospital where I work started new residency programs in internal medicine and family practice. Many of the residents do rotations in anesthesiology and surgery where I have an opportunity to meet and talk with them. They are eager to learn medicine of course, but they are also interested in the perspective that many of us who have been practicing medicine for many years have to ...

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Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship. The problem is that it's extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn't exist. In other cases, it's hard or impossible for the public to find. For instance, if you're getting an esophagus resection ...

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I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest. But this note stood out. In it, the administrator was reminding the medical ...

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The idea that we have to “change incentives” for physicians is all the rage. Oceans of ink are being spilled over the transition away from the traditional fee for service payment model to a menagerie of value-based ones. At the core of much of the discussion about how to make the transition is figuring out how risk-bearing organizations like large physician groups, health systems, ACOs and the like are going ...

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Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to ...

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For most of residency, I missed the opportunity to care for veterans -- mainly for selfish reasons, including my unwillingness to learn a new EMR and hospital. Once I became a chief resident, I realized that I would be spending four months at our local VA hospital. When I first came to the VA as a chief, my goals were similar to that at any other site at which I work: Get ...

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Good luck medical students this Match Day!  In the meantime, watch this wonderful parody from the University of Chicago Pritzker School of Medicine Class of 2016: Matchmaker Matchmaker. (There's serious talent here: They also created the viral Frozen parody, I Don't Know.)

Apologies to Mark Twain, but reports of the death of private practice are somewhat exaggerated. There are still plenty of us around, and most of us are making out quite well. Not all, though. I’m quite sure the murmurs of discontent have reached many ears by now. So much so that many doctors unhappy with the status quo have taken action. One such action is to “go concierge.” Concierge practice, also known ...

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When Donald Trump announced that he was running for president last summer, most people didn’t know quite what to think. Was this serious or some sort of publicity stunt? Would he be in the race for more than just a few weeks of intense media spotlight? Would he be able to stand on a stage and debate other politicians? No matter what side of the political spectrum you fall on, ...

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This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we will say her name) was a highly accomplished physician married to a "prominent businessman" adding to the media-stickiness of the story.  Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims. Yet ...

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On January 5, 2016, emergency crews were called to Our Kids Daycare and Learning Center in Middleton, Idaho. The reason: concern for carbon monoxide poisoning. The daycare center’s director Robin Hagaman noted that some of the 12 toddlers in the classroom were acting strangely when they awakened from their naps and were also noted to have dilated pupils. In addition, two of the teachers were simultaneously experiencing headaches and ...

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