“It’s an 8,” I heard him say from behind the curtain as I walked into the room. The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the tip of his index finger measured his oxygen saturation. “What does an 8 mean?” I asked. “Oxycodone!” he chirped cheerfully, without a moment’s hesitation.  “An 8 means oxycodone.  Five milligrams!” “Ah, but you’re wrong,” ...

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Healthcare Not Fair imagines a world where attorneys, insurers, CEOs, and politicians run health care.  Spoiler alert: It's not pretty.

I slipped and fell. My hip fractured, surgery would make it better. But it didn't. My body was too weak to fight. I couldn't cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn't breathe. I became weaker and weaker, until my family noticed. The medics rushed me into the ER. My blood pressure was 62/34. For how long? The ER nurses and doctors tried ...

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Sometimes when I’m working at the hospital overnight, I go for walks. Every now and then, things calm down in the operating room, and you can get some time to relax. Life moves at such a break-neck pace, especially within the world of hospitals, that taking a moment to reflect, is beneficial. Walking around a hospital at night is very different than during the day. During the day, it feels like ...

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I handed her the humungous gardening shears and watched as she snapped through each rib providing access to the silent heart of our cadaver. Abruptly, the fire alarm rang out cutting short the most physically taxing day of our yearlong anatomy lab course. Once we had evacuated, firemen streamed into the building, and I wondered if my lab-mates were also thinking about the horrific scene these men would encounter as ...

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Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew ...

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Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER. You may get lucky, and find yourself ...

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The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated in a ballroom, which shared its building with a bowling alley, in the heart of Harlem. It was particularly warm inside the building, and we were being served hot coffee while ...

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Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do. Why do doctors over order? These same people thought a ...

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On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years. On April 23, 2015, we lost Kevin Dietl to suicide just weeks before he was to graduate medical school. Kevin's parents were so excited to attend their son's graduation. Instead, they attended ...

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“Hey, Doc!” I heard the patient say as I blazed by bed A. Bed A is the "door" bed. My patient was in bed B, the "window" bed. I had just met him; it was a new inpatient consult. For all the rules and regulations surrounding patient confidentiality, the curtains between beds do little to protect privacy since inevitably there will be audible conversations about symptoms, diagnosis, and management between patients and ...

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I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician "Dr. Barkus Yellby."  Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated ...

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There was a morning where I felt like the smallest human being on earth. It was a morning spent in the OR, where it seemed like I could do nothing right. I placed the Foley incorrectly on my first attempt, and then ended up removing it incorrectly as well. I nonchalantly brushed past the robot we were using for the case, which was already draped and prepped, and whose sterility I ...

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When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of strangers. She came to me hoping I could improve her appearance. The abnormal connection between the arterial and venous halves of her circulatory system caused her cheek, jaw, and neck to ...

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"Do you need help getting undressed?" Jon asks from the doorway of our bedroom, one hand holding his BlackBerry, the other tucked into the front pocket of his baggy jeans. His head is slightly tilted, his eyebrows arched, highlighting his forehead wrinkles. His phone vibrates, drawing his eyes from me to the incoming message. I wait. Jon reads, ponders and then looks up, half-absorbed in what he's just read, and registers that ...

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The U.S. health care system is the world's top in health care spending per capita, but in terms of performance, we're dead last among developed countries. As a young physician embarking on a career in this landscape, it's glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among ...

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I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed ...

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asco-logo I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes always seemed to smile as broadly as she did. “Nice to see you, Doc!” she would say. I ...

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“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s blind.” Puzzled, I looked at my list of patients and, not sure whether I should write “violent” by this patient’s name, I decided instead to write “blind.” I paused. The ...

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We have a problem in our clinic. Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled. There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders. Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty. That ...

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