There is only one correct, perfect, absolute approach to life and decisions near its end.   This truth relieves the doctor of final decision.   The right way lifts the burden of anxiety, confrontation or guilt.   The perfect path makes giving care at a very hard time, much easier. That correct course, the only way to treat every patient and every family, is exactly what the patient and family say it is. This ...

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So, you’ve finished all your job interviews and think you’ve found a perfect fit. Graduating from residency is exciting, but did you get any training on what it all means to sign on the dotted line? Below is a quick and dirty run-down of the contracting process from an industry insider. 1. Non-compete clauses. Non-compete clauses are not just a big med phenomenon; they are part of contracts in many different clinical settings. ...

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The clues are usually there, even in the hardest of cases. They just aren’t presented to you on a silver platter. Gwen Stephenson had an ill-defined polyarthritis and had been on methotrexate for some time. Her rheumatologist, Norm Fahler, had tapered her off the medication while keeping an eye on her inflammatory markers and they had leveled off at just above the normal range. Seven or eight years ago, Gwen had suffered ...

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Clinician educators have the opportunity and responsibility to influence students, interns and residents.  While we can have some hubris in our education skills, we must always demonstrate humility in our patient care role modeling. Dr. Orhan Muren, one of my early role models, often told us to never be “cocky” when taking care of patients.  As I recall his admonition, I realize that he was urging us to have true humility. But ...

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I am constantly coming across articles of physicians with strong voices. Physicians that are jaded.  Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians ...

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“Words are, of course, the most powerful drug used by mankind." - Rudyard Kipling I read Drs. Dhand’s and Carbone’s post with great interest: Physicians are not providers: An open letter to the AMA and medical boards. I began writing a comment; it turned into an essay. I support Drs. Dhand and Carbone in this endeavor. The word "provider" diminishes the people who cure, treat, and heal, whether they're physicians, nurses, nurse ...

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An infectious classic for the holiday season!  Yuletide greetings from ZDoggMD and his adorable kids.

asco-logo The past year had been a tremendously exciting time to be an oncologist, and to be a lung cancer oncologist in particular. It seems we hardly have time to get used to one newly approved agent before another one becomes available. In 2015, we have seen gefitinib (don’t I know you from somewhere?), afatinib, nivolumab (twice), pembrolizumab, necitumumab, and osimertinib all ...

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11045478_742642892507962_670861048466897224_n I can’t tell you how many people have flung this Facebook item at me since last night, starting with my wife. It’s already approaching 25,000 shares. Listen, people: Googling does not mean I think I’m a doctor. It’s a sign of being an engaged, empowered “e-patient.” I partner with great doctors -- I don’t tell them what to do. And they welcome me doing it. I personally am completely ...

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Between September 9th and October 6th, 2015, the consumer-level computer world was turned completely on its head. In early-September, Apple hosted its annual iPhone press release that announced the redesigned iPhone 6s and the iPad Pro. A little over one month later, Microsoft announced a bevy of new devices, including a redesigned Windows Surface Pro (they are now up to the Surface Pro 4) and the unanticipated but incredibly intriguing ...

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The fact that primary care is undervalued by Medicare and other payers has been long understood to be driving the precipitous decline in the numbers of new physicians choosing primary care internal medicine or family practice, and a growing exodus of established primary care physicians. Efforts to address this undervaluation have traditionally been to, 1) bump up the payments (relative value units) for the office visit codes traditionally billed by primary ...

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As a third year medical student, I am as green as they come. As much as I feign familiarity in the hospitals, each day of every rotation brings a host of firsts: first time suturing, first natural delivery, first terminal patient, first 24-hour shift, first code blue. The novelty of these experiences is equal parts exhilarating and overwhelming. As future physicians, we have invested the better parts of our time, ...

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At some point in our lives, and it probably happens more often than we’d like to admit, we fake it. Let’s get real, shall we friends? Think about it. Your mother is having heart surgery in a small town across the country. You are, frankly, worried sick. Do you tell anyone in the operating room, especially your patient? What would you do? If you’re like me (OK, this was me recently), you fake it. You smile at your ...

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A presentation given to the bioethics committee, Sacred Heart Hospital, Pensacola, FL. My presentation today is about the challenge, professionally and emotionally created by certain external forces, which encompasses bioethical issues when one's roles merge. I am privileged and blessed to have many roles in my life: physician, wife, daughter, mother, now grandmother, sister, aunt, friend, and colleague.  At times, these roles blend, other times, they are murky and can cause intense ...

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I remember attending an eight-hour seminar on my job, where experts educated new nurses about the transition we would experience in our profession. We learned about the change theory and the different levels of transition, from novice to expert. I remember not taking the two-day session very seriously, thinking that my accelerated three-year nursing degree had prepared me well for the workplace. Now that my one year of practicing as ...

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"How much experience do you have with human suffering?" It was a question asked of me at my first medical school admission interview, and it took me by surprise. I was expecting to be asked about my volunteer experience, my research, or my desire to become a physician. The simple truth is that most of us really don't have that much experience with human suffering when we're in our 20s. The ...

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As a pediatrician and future mother of black children, I am worried. I am worried about my patients who face possible death if they appear threatening to the wrong police officer, like Tamir Rice. I am worried about my patients who might be sleeping peacefully in their families’ home when law enforcement officials burst in with grenades like the ones that killed Aiyana Stanley-Jones. I am worried about my teenage ...

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There was a time within my professional lifetime when old records would arrive on the medical ward in a wheeled wire basket, multiple volumes with shabby pages. And in the VA of the 1980s, which still had veterans of World War I who never lived anywhere else the previous half century, the forklift could deliver not only the charts but the x-ray films that had not yet been sent to ...

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As the awareness and recognition of concussion in sports continue to increase and the frightening long-term outcomes for frequently and severely concussed athletes are realized, as a physician I cannot help but advocate drastic changes in football.  Of the major sports, it sees the highest rates of concussion, and for every highly publicized Greek tragedy of a broken NFL star (Jim McMahonJunior SeauDave ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm ...

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