"It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended." – Joan Didion, Goodbye To All That So it feels at the end of residency. Of course, there is a graduation date. ...

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I was a few weeks into my surgery clerkship and was on the tail end of a student call shift. I had been at the hospital for almost 24 hours, and the last thing left to do before I embraced the comfort of my own bed was to round with the faculty surgeon on call that weekend. The night had been busy, but I was prepared to update my attending ...

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It’s likely that you or someone you know has attempted to purchase tickets, or at least talked about the difficulties of purchasing tickets to Broadway’s most popular show, Hamilton. While participating or overhearing the discussion, the conversation has likely pivoted to how expensive ticket prices are on the secondary market. It has become so difficult to get tickets through the box office, even with the partial block ticket releases that ...

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Many people, even those who work in the operating room every day, take safe anesthesia care for granted.  There has been growing pressure recently to abandon the team model and remove physician anesthesiologists’ supervision of nurse anesthetists with the latest threat coming from within Veterans Affairs (VA) health care.  For our veterans, our heroes and arguably some of the most medically complex patients, having both physician anesthesiologists ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. “Before we end the meeting, I would like to thank our staff, without whom none of this would have been possible …” I can’t count how many times I said that or something similar when I was the American College of Physicians’ (ACP) Rhode Island ...

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As she adjusts her sunglasses, Mary squints to protect her sensitive eyes from the sun.  Four years ago when lymphoma threatened her life, doctors gave her a 5 percent chance of survival. “I really should be dead right now,” she states casually. A bone marrow transplant gave this patient a new lease on life, allowing for the treasured opportunity to mother her 8-year-old son. The transplant has been successful, but her ...

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It has now been confirmed that Prince’s untimely death resulted from an overdose of the drug fentanyl. It is unclear whether the lethal dose of fentanyl was a prescription medication or a counterfeit “analog” drug from the illicit market. Regardless, the facts are now clear enough to know that the U.S. health care system failed Prince in the same ways it is failing the 78 Americans who die every day ...

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In 2008, mental health advocates hailed the Mental Health Parity and Addiction Equity Act as “historic;” putting an end to what Sen. Edward Kennedy called “the senseless discrimination in health insurance coverage that plagues persons living with mental illness.” The law requires most group health plans to offer coverage for mental health and substance use disorders equal to that provided for medical problems. Two years later, the Affordable Care Act extended ...

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Follow-up appointments at my continuity clinic have given me the opportunity to look at my clinical judgment in snapshots.  Unlike on my inpatient rotations, where I see the same patients every day,  I have to wait for a month or two to see if a medication is working, or if a patient is satisfied with their progress in physical therapy.  Sometimes I have a crisp memory of my clinical decision-making ...

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A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury.  Thank you for your insightful article and feedback.  You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.”  You (the patient) and me (a physician) are now in the same boat, headed the same direction with the ...

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It sounded too good to be true when I first heard about Theranos, a company that promised to revolutionize medical testing by making it possible to perform dozens of tests on a single drop of blood, rather than the several tubes that would typically be required. And that wasn't all. Theranos CEO Elizabeth Holmes, a Stanford dropout and media magnet whose wardrobe seems to consist solely of all-black outfits, promised ...

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Dear parents, Congratulations on your daughter’s acceptance into medical school.  Like the first day of kindergarten, this launch is notable for parents as well as children. You may have some concerns about the stresses she will face. Having been there, I can tell you there will be many.  Not to worry, though. Times are changing.  You daughter is free to learn among the brightest of the bright while avoiding problems women before ...

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"We experienced an iatrogenic event that produced an untoward sequela, and while it is now quiescent, it may still recrudesce." No one likes to be given bad news, especially of disease.  But first, you have to understand what it means.  When it comes to communication of medical information, the way the message is delivered is often just as important as the information itself.  Indeed, good communication is the backbone of every patient-provider relationship. The ...

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When my friend Madeline turned seventy, she celebrated in a big way: She walked a half-marathon; she hosted a cabaret for family and friends at which she sang and told stories; she traveled to China. Now, six years later, this dynamic woman has become a virtual prisoner in her apartment. She has undergone back surgery, suffered a nearly fatal intestinal infection and, after a fall, had bolts and screws placed ...

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Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube? All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t. It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional mishap with ...

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Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring ...

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To the American Board of Pediatrics: I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is ...

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Ezekiel Emanuel, the University of Pennsylvania physician and ethicist, has written an opinion piece suggesting many changes in both pre-medical education and the medical school curriculum. He would do away with many of our hallowed medical school prerequisites such as calculus, physics, and organic chemistry, feeling that those subjects are simply used to "weed out" certain students. I confess I once believed that such subjects were worthwhile. However, Emanuel makes a ...

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One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as ...

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