I am forced to write anonymously because of gross neglect by my residency program regarding standard ACGME duty-hour rules. If my name were published, it would identify my program. As a PGY-2, I worked 100+ hours per week on average last year while taking primary call for my urology department. (Admittedly, the PGY-2 is the historic “worst year” for any urology resident.) On a quarterly basis (depending on manpower), we take ...

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When I started medical school, my classmates and I attended a special ceremony where we stood in front of our friends, family, and professors and recited some modern version of the Hippocratic Oath. For years afterward, I only remembered the “do no harm” bit, which is a lazy approximation of the actual words. I recently reread the oath, and even though I’d completely forgotten, it also said this: “I will ...

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My mom had Alzheimer’s. And she gave me secondhand Alzheimer’s. Haven’t heard of secondhand Alzheimer’s? I’m not surprised. I think I coined the term. The way I saw it, either I had some devastating disease as a result of taking care of Mom with her devastating disease, or I was a complete jerk. Since I didn’t want to think of myself as a complete jerk, I decided I had secondhand Alzheimer’s. ...

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One of my favorite things about being an entrepreneur is the people I’m privileged to meet and spend time with.  This week I met a fellow Montana physician, Alistair MacDonald, who has started his own company.  He’s created a product that automatically decreases the volume on music playing in the operating room if a patient's vital signs are tanking.  It seems like an important idea to me.  He made some ...

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It was Albert Einstein’s “biggest blunder.” Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together. In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, ...

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We are at a watershed moment for health care, both nationally and in Massachusetts. Massachusetts, the state that first piloted the model, "Romneycare" in 2006, that was disseminated to the nation as "Obamacare" is now going full steam ahead with ACO models under the newly approved 1115 waiver, that received the CMS green light in early November. Having expanded to near universal coverage in 2006, now, at the end of 2016, we are taking on ...

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I was about 13 years old. I heard that she had cancer and I went to the hospital to visit her.  Her name was Sister Pat, and she was my former principal and my favorite teacher from elementary school. I don’t think she had reached her fortieth birthday.  I was too young and uninformed to ask about any of the details.  However what stuck with me and I remember so ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated at a well-patient visit. Both her parents have a history of nonmelanoma skin cancer within the past year, and she is seeking counseling regarding skin cancer prevention. She has a history of remote sunburns and had previously tanned as a teenager. She requests advice on how ...

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The medical assistant swabbed my nose and my throat multiple times. Pricked my finger too. Then, the phlebotomist (or vampire?) drew bottles and bottles of my blood. Along with the physical discomfort, there was emotional discomfort too. What would the test results show? If they were all negative, would I be satisfied without having an answer? Being a patient can be extremely vulnerable. Not only do you often divulge to a ...

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I spent the evening of the 2016 presidential election and the morning after on an emotional rollercoaster. It began high and then descended into shock, disbelief and grave concern about the future of our country. Now that we have selected a candidate who intends to take the country in a radically different direction, and I worry about the consequences of reversing the Affordable Care Act, reversing economic assistance programs, and ...

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When you hear people say, “I don’t want to vaccinate my kid. Why would I give them autism?” It’s hard not to get upset and meet your patients with some judgment. John and Carly were middle-class Americans that had a lot of misconceptions about vaccines — mostly from the media. They loved their two-year-old daughter Leslie and wanted the best for her. They didn’t understand that we wanted the same thing. ...

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Quick, name the most watched, financially successful and competitive sports league in the United States? The NFL. Right? Now, name the most tightly regulated, transparent sports league, one that has a multilayered system of wealth redistribution and the one of the strongest unions of any profession in the United States? The NFL. Surprised? This is not a coincidence Major problems with concussions and Roger Goodell’s persona and salary aside, the NFL offers a tremendous lesson ...

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As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues: “Should I be resuscitated if my heart stops and I stop breathing?" “Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?” “Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?” “When should we refuse tests for ...

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Tests and exams are the most challenging part of campus life, especially when it is in medical school where students will frequently encounter different types of examinations. One of the things which makes it special is that in medical school, exams are not only given as a written examination but also as oral and practical examinations in which students must face their instructors. Most of the time these are external ...

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Recently, President-elect Trump selected Rep. Tom Price, MD to lead the Department of Health and Human Services.  Suffice it to say, this signals Mr. Trumps’ resolve and commitment to definitively repealing and replacing.  Dr. Price has already sunk his teeth into health care reform, having proposed alternative health care solutions in every Congressional session since 2009. As a physician myself, I am delighted at the prospect of having another doctor at ...

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On Tuesday, November 29, President-elect Donald Trump named Dr. Tom Price, a former orthopedic surgeon, current Republican congressman, and chair of the House Budget Committee, as his pick for Secretary of Health and Human Services. The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position. The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to ...

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Madame Laurent came to my office one day last year with bloodshot eyes and a two-day headache. She’s well known in our clinic – kind to all the staff and always smiling even when she’s in pain. Despite a stroke a few years ago, she is mentally sharp, often able to read what I want to say before I can say it – an impressive feat considering that she only ...

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For a century, the white coat has been the symbol of the medical doctor. Today, the vast majority of medical schools in the U.S. begin with a white coat ceremony. There, the fledgling, future doctors stand together and recite a modified version of the Hippocratic Oath before being called up one-by-one to receive the white coats that they will wear throughout the upcoming trials and adventures of medical school. The ...

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You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of the report as you mumble report after report into the system. You will never know my story. I am my organs to you; organs will anomalies that you have to squint and sometimes lean back to look for.  You ...

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Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it's tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact. There seems to be two broad schools of thought about the causes — and by extension, the fixes — of physician burnout. The first focuses ...

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