Danny rarely came to the clinic. He paid a sliding scale fee for the visit but this, in addition to the money he paid for his medicines, was already too much for him to afford. Now, in early November 2013, he had become concerned. Danny had previously owned a jewelry boutique with his wife, Jacky. She made her own pieces and sold them in the store. Over time, the economy had ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has a history of severe COPD diagnosed 4 years ago and previously had minimal exertional symptoms. However, he now notes shortness of breath when walking short distances that is limiting his activity level. He does not have ...

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"So, that's it? Huh. Well, there's not much to say.  I didn't think I wanted it ..." "It" was a heart lung transplant.  He, my patient, was 30 years old. We had just learned that he was 100% sensitized with antibodies to any donor.  He would not be offered a transplant as he was certain to reject the precious gift of these organs.  As he would have said, his body had ...

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The other day, the last two appointments on my schedule were "unable to get pregnant, consult" and "pregnant, desires a termination." Even my medical assistant commented about the timing of those last two patients. Although these are not unusual issues for patients to see me about, the fact I was seeing them back to back, haunted me all day. Why? Why did life deal them these cards? Did fate make ...

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Compare the following two versions of the same medical history: Version 1 CC: chest pain Mr. Smith is a 57-year-old white man who comes into the office today for the first time with a complaint of chest pain. He states he has been in generally good health in the past, though he has smoked about 40 pack-years and admits to not exercising much, other than occasional games of golf. He has trouble keeping ...

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I love teaching my children about history, and in the process, I often see a clearer perspective of events I learned about at a young age when I had less life experience under my belt. As I have been revisiting the evolution of our country, the formation and restructuring of our society, and the emergence of periods of oppression, rebellion, and social change, I have been struck by the concept that ...

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One of the most respected and skilled clinician-educators — of course, he is an infectious diseases specialist — at our institute came into my office, sat down and immediately starting eating pretzels. “Let me know what you think about this,” he said between bites. He went on to recapitulate a recent interaction he had with the members of the internal medicine team (medical students, house staff and the attending physician) ...

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William Osler once said, “Listen to your patient; he is telling you the diagnosis.”  Anybody who practices medicine knows that is easier said than done. The ability to take a skillful history takes years to develop. There are many nuances in a medical history and physicians must know the right questions to ask. The next step is to avoid asking the wrong questions and the wrong wording of the right ...

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I want you to know about colds, and integrity. Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either. Truthfully, as odd as this sounds, I wish could find ...

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"Does he speak English?" As I was busy working at my computer dictating on the last patient, I overheard the question posed to my receptionist.  The receptionist, unfazed, responded with a polite, “yes.” My medical assistant ushered the patient into one of the exam rooms where Ms. Smith proceeded to expound on how she had experienced some less than ideal interactions with Indian physicians -- they had seemed cold and curt; their ...

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Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on. I dial the call-back number. "Pod A," a caffeinated voice chirps. It's Candice, one of the nurses. "Hi. Amy here, returning a page," I murmur. "Oh hi, ...

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To my friends who view abortion as a betrayal of their religious values: I want you to know that I love you for who you are and understand where you are coming from. I grew up with many friends for whom the church was an important part of family and community. I was, perhaps unwittingly, towed along to vacation bible camp” at said friends’ churches and for several summers in high ...

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I asked a group of docs I’m coaching how much they’re worth per hour. Interesting question given docs have 11 or more years of specialized training beyond high school. Surgeons spend most of their 20s and 30s in school. By the time these folks graduate, they’ve got 200K+ med school debt — before the kids, spouse or house. Many docs just don’t have time to develop a social life, fall ...

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Whether rejoicing or mourning, millions of Americans awoke on January 21st feeling suddenly at the threshold of a new and uncertain era. However, in public safety-net emergency departments across the nation -- like Harborview Medical Center in Seattle, where we work -- the service of healing continued seamlessly, paying no heed to the national drama that has unfolded for the past several months. That day and into the night, there were ...

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Hospitals have lots of codes. The most famous one is Code Blue (medical emergency), but it turns out there are lots of color-based codes. This can be confusing, as the connection between the code colors and the situations they represent are usually tenuous at best. Today we explore all of the types of codes, and shed some light these arcane medical euphemisms. Code Blue What it sounds like it means: Aggressively-scented cologne from Armani. What it actually means: ...

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For those who are not avid followers of President Trump or his decisions, often his decisions have far-reaching consequences that affect lives and people.  As a health care provider, I understand quick decision making, but also the importance of risk versus benefit and consequences of your decisions.  I would like to tell you my story and how his actions have affected my life, the lives of my patients and their ...

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It was 3 a.m. and 3 degrees outside, and I was about to discharge Mike from our emergency department for the third time in less than 24 hours. "Doc, let me finish this episode," he said, his eyes glued to the TV in the ER waiting room. Mike was homeless, and this was our routine all winter last year, when it was too cold to sleep in shop doorways or the bridge under ...

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As I've listened to the confirmation hearings for cabinet nominees, I’ve realized that no one with health care IT expertise has been identified by the transition team. I continue to ask all my colleagues about any contact they’ve had with anyone advising the new administration. So far, no one has been asked anything by anyone related to health care IT. At this early time in the administration, it’s important to offer ...

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Two months into my private practice career, I was assigned a “no doc” patient, a term referring to a child without a regular physician.  This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six-week-old son. He is your responsibility now.” If I have learned anything over the last 15 years, ...

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Brian is one of the coolest nurses I have ever met. Overall, he is a cool dude. Sporting a sleeve of tattoos, he has swag. We have been side-by-side in many traumas and sick medical arrests. He always remains calm, cool and collected as he navigates the resuscitation bay. So, when Brian ran into the pediatric ED looking a little flustered, I knew we were in for something. “I just got ...

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