Patients: Accept your fate as a hamburger Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units. The name of the game today is efficiency -- i.e., ...

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Jewish history has all too often been written in tears … I am fascinated by people and groups with the capacity to recover, Who, having suffered the slings and arrows of outrageous fortune, Are not defeated by them but fight back, Strengthened and renewed. - Rabbi Jonathan Sacks, PhD,To Heal a Fractured World In some situations, the whole idea of complete recovery from bereavement makes no sense.  Bereavement can be fully expected to last a lifetime.  ...

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Terrifying truths about health care IT One would expect that in an era where smartphones are more powerful than our computers were 5 years ago, health care providers would have an arsenal of health care IT solutions to enhance patient care but also optimize their own workflow. Shockingly, in 2014 most health care IT solutions (such as EHR systems) are incapable of basic functions that we take for ...

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What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, ...

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When is it right to share our personal struggles with patients? I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. ...

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I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift ...

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What primary care can learn from the financial service industry Man looks into the Abyss, and there's nothin' staring back at him. At that moment, man finds his character, and that's what keeps him out of the Abyss. - Lou Mannheim (Hal Holbrook) in the movie, Wall Street We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health ...

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Carl didn’t know what was happening to his wife. The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years.They had one daughter, Thekla, and their marriage had always been harmonious -- that is, until one Spring day in 1901 when Auguste suddenly exhibited signs of jealousy. Auguste accused Carl of going for a walk with a female neighbor, and since then, she had ...

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Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash. I wish we could say the same for the U.S. health care system. Nationally, problems with health care quality (doing too much, doing the wrong things, and doing too little when indicated) are pretty clear. The bigger problem is that the progress has ...

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Oncologists have one of the lowest burnout rates. Why? The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn.  In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on.  After the finish, the parking lot empties, the lights go out, and ...

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At the national conference of the American Academy of Pediatrics (AAP), I got to hear Hillary Clinton talk about the AAP's partnership with her Too Small to Fail campaign. It made me happy -- and sad. The partnership is a great idea. It's all about improving early childhood literacy, which is way more crucial than most people realize. It's not just about an income gap when we talk about the ...

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Physician suicide 101: Secrets, lies and solutions This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC. Why did you go to medical school? I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction ...

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Why do drugs cost so much? Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. ...

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Anesthesiology used to be a job that was attractive for people who don’t like patients very much.  The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done.  Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the ...

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When patients seek a second opinion: Its not about you I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come ...

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As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic. A student in the postgraduate course in research ethics that I teach at Albert Einstein College of Medicine recently asked whether we could discuss the Ebola epidemic in class. Because I had prepared the syllabus for the course months ago, I hadn’t ...

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In my administrative role, I have the great pleasure of signing thank you letters to patients and family members who have acknowledged the great care they have received by one of our physicians or other caregivers. It is a nice way to tell the patient “we got your note” and to simultaneously recognize the provider by copying her or him. The best part is that I get to read the ...

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When a doctor cries The calls came simultaneously.  One from the hospital and the other from a nursing home.  Two deaths separated by fractions of a second.  My heart swelled.  For a moment.  The pile of papers on the desk softly whispered.  My mobile howled jealously vying for my fragile attention.   I could feel the emotion drain as I turned back to the task ...

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The most valuable lesson about teaching that I ever learned occurred in high school. I took my first algebra test. The questions were easy, and I wrote down the answers. All my answers were correct, but I got a B. After each answer, she wrote “show your work.” She explained that while algebra questions start out easy, they become more complex over time. Only through careful understanding of ones thought ...

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