The concept of sickness insurance began in Germany in 1883. Chancellor Otto Von Bismarck initiated insurance for the poor. A decision about how these services were to be delivered is critical to understanding the contentious debates around health care. Could Bismarck have given vouchers for care as needed? Alternatively, should the government control the needed health care facilities? Perhaps thinking the poor did not have the capability to manage their own health, he chose ...

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Winter break back at home with my family may as well have counted as a preceptorship session or two. Ear infections, the common cold, the flu -- if you can name it, there's a good chance someone in my family caught it. We have never collectively consumed as much cough syrup, pain relievers, and antibiotics as we did over these last two weeks. Seriously, the quantity was awe-inspiring. Even though each ...

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Much of the discussion surrounding the presidential election this year focused on fake news.  There were countless stories in newspapers and on television news shows about these obviously biased and fictitious posts that might have affected the outcome of the election. I could not help thinking during this campaign season that if you think fake news is bad for politics, you should try being a physician. As physicians, we are on the ...

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My first week on call, I got called in for a code blue. This patient happened to be the sickest patient on our unit. He had a tumor on his brain stem that was affecting his vision, hearing, swallowing, and breathing, so he had received a tracheostomy and gastrostomy tube as most palliative patients in his situation do. After a series of neurosurgeries, he was undergoing chemotherapy and radiation treatments. ...

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Well, I'm officially that old, bitter resident. I had to walk uphill to medical school 10 miles there and back. “In my day,” medical school was fail, pass, high pass, or honors. I recently found out that the medical school I graduated from has changed the first two years of basic science courses to simply pass/fail (while retaining the honors/high pass grades in clinical rotations). I am so annoyed!  Why ...

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Most third medical students look forward to their psychiatry block. After twelve plus hour days and six day weeks on internal medicine, OB/GYN and surgery, the reasonable hours on psychiatry seems like a dream. While my classmates viewed psychiatry as a break, I dreaded it. This was not my first time on an inpatient psychiatry ward. My world and fate forever changed when I was twelve years old. Sometimes depression is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old man is evaluated for a 3-month history of depressed mood, poor concentration, decreased energy, increased sleep, and weight gain. He reports missing many days at work and that his work performance has lagged. He has no suicidal ideation. He states that his current symptoms differ markedly from his usual state ...

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While having coffee the other day, I came across a video called The Thank You Project. Watch it. I assure you, it’s worth 5 minutes of your time. In 2004, Kellie Haddock, her husband, and their 14-week-old son were involved in a horrible car accident. Her husband was killed on impact, and their son was severely injured.  In her heartbreaking tale, she recounts the roller coaster ride she endured ...

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Incoming students, you need to hear this: it’s not all about you. Let me explain. My first hospital rotation was on an oncology floor. I answered a patient’s call light by myself. She asked if we had any extra tissues, I said yes, and as I turned to leave she said, “I just got a phone call from my mother’s nurse.” Her mother was in hospice care, and the nurse had ...

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Halfway through the “Bell Curve,” which is an analysis of differences in intelligence between races, I realized what had been bothering me about Charles Murray’s thesis. It wasn’t the accuracy of his analysis, which concerned me too. It was what he analyzed. The truth, I used to believe, was always beautiful, whether it was what happened in the multiverse at T equals zero or the historical counterfactual if ...

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You submitted your application in July. You completed all of your secondary essays by mid-September. Other than one interview that resulted in a waitlist decision you’ve heard nothing but radio silence. What can you do? Whenever I work with medical school applicants I emphasize that the application process is ongoing because the admissions process is fluid. It is not as if you submit your primary application and secondary essays and the ...

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“And then he said, ‘I … I just want to help people you know?’” The table burst out laughing. I struggled not to spit out my breakfast burrito while chuckling. The laughter slowly died down, and I took another gulp of stale hospital coffee. My classmate was recounting the story of one of the pre-med undergraduates he had begun to mentor. I was too tired to think clearly about why ...

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Chapter 1: Physiology “I am a brain, Watson. The rest of me is a mere appendix.” - Sir Arthur Conan Doyle Bound by flesh and bone, therein lies a mystery of undefined potential which the cosmos cannot even parallel in mystery and in complexity beautiful and terrifying. It is that which allows movement to leave the study hall beneath the starry sky, professors to lull us to sonorous sweet slumber, to remember minute ...

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An excerpt from Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine. Mark Linzer’s research identified workplace chaos as one of the key predictors of physician stress, burnout, and intention to ...

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A before and after study at the University of Vermont Medical Center found that a 24-item operating room checklist did not significantly reduce the incidence of any of nine postoperative adverse outcomes. More than 12,000 cases were studied, and outcomes included: mortality, death among surgical inpatients with serious treatable complications, sepsis, respiratory failure, wound dehiscence, postoperative venous thromboembolic events (VTE), postoperative hemorrhage or hematoma, transfusion reaction and retained ...

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Seconds after I arrive at the ER on a Sunday afternoon, I'm called to see an elderly woman who can't breathe. She's ninety-four, and gurgling for air. On my way, I pass two middle-aged women. They are hovering outside a nearby room, trying to get my attention. One gestures like a traffic guard as she tries to wave me into the room. The other throws up her hands as I ...

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  Since finishing my residency several years ago, I’ve worked in almost every type of hospital up and down the East Coast, from big urban academic medical centers to more rural community outposts. Although I primarily practice hospital medicine, working with both smaller private groups and being a hospital employee, I empathize a lot with my independent practice colleagues and brethren. I almost certainly would have gone down the route of ...

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Running has been a constant in my life, and it always will be. I’ve gone on runs in snowstorms and 100-plus degree heat waves, Christmas mornings and birthdays. That hour or so dedicated to running is sacred, reserved for a few minutes to clear my head, a sort of reset button to each day. I’m surrounded by nothing but the sound of shoes hitting the pavement and gasps of heavy ...

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Dear Mrs. J, I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together ...

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Robert Kennedy, Jr. is an activist, author, and attorney specializing in environmental law.  He is the son of Robert "Bobby" Kennedy, a former U.S. attorney general, and the nephew of former President John F. Kennedy.  Kennedy is president of the board of Waterkeeper Alliance, a non-profit focused on protecting and enhancing waterways worldwide.  He has written a book about the damaging effects of vaccinations due to thimerosal, and to round ...

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