I joined physicians nationwide last year in cheering when Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Not only did it eliminate the congressional budgetary fiction known as the Sustainable Growth Rate (SGR) formula, it also promised to simplify and improve Medicare’s costly and complex programs that purport to measure the quality of care we provide to our patients. Unfortunately, as we review the draft implementing rule, ...

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Your medical school personal statement is one of the most important components of your application. This short essay can be the deciding factor as to whether or not you will spend the remainder of your life practicing medicine. To be honest, most personal statements will be similar enough that they’ll fit right in with the rest. There will be a handful that stand out above the majority, and if you can ...

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Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, ...

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I remember a warm September day at the playground 22 years ago. I was there with my 19-month-old daughter and newborn son. Zack was hungry, so I sat down on a bench to nurse him -- but every time I got him settled, Michaela ran away from me. Far away, out-of-view away (she was a quick little thing). The playground was fenced in, but there were lots of ways for ...

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A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any ...

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Doctors have become a profession of whiners.  Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away. It was not always so.  Medicine is a career where idealism runs rampant.  In medical school interviews, young students really do answer that they want to help their fellow man.  Nonetheless, in recent years ...

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I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired. Sure, I get irritated and frustrated with the absurdities of life, as ...

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My last column told the stories of two patients from whom I learned important lessons about gratitude and compassion.  In this column, I share stories about patients who taught me critically important lessons about truly listening and the power of acceptance. Samantha -- or Sam, as she preferred to be called -- was a young surfer recovering from a serious car accident, and Paul a young father with cancer. ...

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I’ve had the chance to present the changes being brought by the Medicare Access and CHIP Reauthorization Act (MACRA) to audiences of hundreds of physicians -- at ACP’s Leadership Day on Capitol Hill, ACP’s Board of Governors and Board of Regents meetings, several educational sessions and a news briefing at the College’s Internal Medicine 2016 Scientific Meeting, and to the California Medical Association’s Leadership Academy.  I’ve also had chats with ...

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The College of American Pathologists shares the story of a Lisa Aaronson, and role of genetic testing in her pregnancy.

As a locum tenens physician in rehabilitation hospitals, I see patients with some of the most unique injuries. From rare brain infections contracted in exotic lands, to the consequences of ill-advised horseplay with guns or ATVs, I’d begun to wonder if maybe I’d seen it all. And then I met a grandma from New Jersey, who had a life-changing encounter on a nature trail out west. In her dutiful effort to ...

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Sagrado Corazon de Jesus hospital hallway As a doctor ready to finish my residency in anesthesiology, most people would assume I am thrilled to be at the finish line of this long, challenging and grueling process. While I am happy to move on and begin practicing on my own, I am also somewhat terrified of what lies ahead. It’s not caring for patients ...

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It was recently reported that medical errors are the third-eading cause of death in the United States after heart disease and cancer. The estimated number per year is over 400,000. This is not new information, and unfortunately, this will not be a simple problem to fix. A portion of these deaths result from health care providers lacking resources and being overextended, both contributing to making errors. Some will also result from ...

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Physicians today are not held in the same high esteem as they used to be.  We are often portrayed as callous, intolerant, clutch-fisted, know-it-alls who schedule patients around our daily golf game.  (For the record, I do not play golf.)  Physicians are accomplished in the application of science, but we are not experts in public relations. We are human beings: mothers and fathers, sisters and brothers, sons and daughters.  Like everyone ...

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Dads play a critical role in their kids' development.  Happy Father's Day from pediatrician-rapper Young IV!  

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12. On physical examination, vital signs are normal, as is the remainder of the physical examination. Upper endoscopy discloses a 6-mm polyp in the ...

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To her it was like any other day. She had dropped him off, as was their usual routine, and gone into the city to see a friend. He was an experienced member of the ski team. Practice was familiar. Take the lift up, ski down. Take the life up, slalom down. Take the life up … It all happened quickly. He slipped through rail of the lift. The impact on the cold, ...

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The term, "evidence-based medicine" (EBM), provokes strong feelings from its proponents and its skeptics.  I spent a full day recently in discussions about EBM.  As the day proceeded I understood that evidence is wonderful when it fits the clinical question, but that too often the clinical question does not, and probably will not have adequate evidence. We have great evidence for some clinical questions.  We all know that ACE inhibitors decrease ...

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“Customer service” is the new buzzword in health care. (Yes, I know it’s two words. Stay with me here.) Health care has become a service industry, like a restaurant or a company that comes to your home to replace a broken windshield. The shrimp is too salty, or the tech left footprints on your floor mat? You complain, and you send the shrimp back, and the tech apologizes and says ...

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I was really anxious.  My father's legs were getting weaker and his pain was worsening.  He had been having pain for quite a while, and that pain was often disabling in its severity, but the weakness was alarming. Dad went to the neurosurgeon, who was also alarmed at the weakness, but didn't feel that the problem was surgical in nature.  When I heard this I broke one of my most tightly-held ...

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