“There are three kinds of lies: lies, damned lies, and statistics.” There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical ...

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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

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Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry. Some polypharmacy is rational -- e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer. But most polypharmacy is ...

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The patient arrived in the pediatric intensive care unit one summer early in my medical training. The weather was still warm, although the unforgiving heat from earlier in the season had mercifully passed. The whole thing had been an accident: The child, a toddler, had been left in the car outside her father’s office, discovered several hours later when the father returned to retrieve a document from the back seat. ...

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This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place. The other day, a family mentioned having their “rainbow baby” referring to a child born after a tragedy.  To me, rainbows symbolize that even after the roughest storm, things can get better.  To see a rainbow, there must be moisture, like falling rain, in ...

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I accompanied my husband to an office visit with his orthopedic surgeon. Jamie had been experiencing setbacks in his recovery from major surgery. I went with him because I understand how hard it can be to distill medical information on the spot, much less remember it. Documenting what the surgeon said would allow us both to reference it later. The more information Jamie had about his condition, the more of ...

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If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist, I would have thought he had lost his mind.  As the career medical director of community-based cancer centers, I was used to running the show.  And as the saying goes, I ran a “tight ship.”  Consultations were performed and documented in a timely fashion, day of the request if the ...

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When Arnold Schwarzenegger was governor, he decided that you and I don’t need to have physicians in charge of our anesthesia care, and he signed a letter exempting California from that federal requirement. Luckily most California hospitals didn’t agree, and they ignored his decision. When he needed open-heart surgery to replace a failing heart valve, though, Governor Schwarzenegger saw things differently. He chose Steven Haddy, MD, the chief of cardiovascular anesthesiology ...

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In the wake of the horrific Orlando shootings, there has been renewed attention given to the U.S. Food and Drug Administration's (FDA) so-called ban on blood donations from gay men.  A congressman called the ban discriminatory, and demanded it's repeal -- a call joined by the American Medical Student Association. I can understand how many gay men feel.  I often donated blood at various American ...

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Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me. ...

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On the morning of the tragic mass shooting in Orlando, a tweet by CNN stated, “The White House waived HIPAA regulations so that hospitals could talk with family members of shooting victims, says Orlando Mayor Buddy Dyer.” Many, including me, retweeted this thinking that it was probably unprecedented. Later that day, several Twitter followers informed me that HIPAA had been waived during Hurricane Katrina. Despite rumors to the contrary about 9/11, Katrina ...

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Ronald Reagan’s last letter to the American people, penned with his own hand in November, 1994, went directly to the point: “My fellow Americans, I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer’s disease.” In this deeply poignant moment, the former president explained that he decided to share his diagnosis “to promote greater awareness of this condition,” with the hope that doing ...

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There’s a lot of fear and anxiety about the job market with recent medical school graduates. The 2008 crisis almost collapsed the housing market and many of our large banks, prized institutions, and beacons of financial stability, dissolved overnight.  If you combine these events with the financial burden of student loans that many graduates have, it’s easy to see why many medical students are somewhat skeptical of the job market. In ...

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No couple ever expects to visit a fertility doctor. However, 10 to 15 percent of couples suffer from infertility. This means that approximately 1 out of every 8 people you know are struggling to conceive and seeking help to grow their family. I can only imagine how hard it must be for a patient struggling with infertility to walk into clinic and see that their infertility doctor is also pregnant. ...

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My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.” 6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed. A tense ride home, then the revelation. “I've been having difficulty ...

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I don’t want to need it. That is a thought that has been all too familiar to me when I venture on the patient side of health care, an industry that I study as a scholar as well with the distance of one investigating a foreign land in which they do not intend to become entrenched. It is a thought that has been all too familiar as I see added to my ...

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I glanced at my watch before responding to the pager. It was almost 2 a.m., with the end of my 24-hour call as the in-house surgery resident still dangerously far away. The page was for a new consult from the medical service, on a patient with necrotizing pancreatitis. Apparently, she had been in the hospital for over a month, in and out of the ICU with multiple drain placements, and ...

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During a busy ED shift, my computer signaled the complaint and location of my next patient: a woman in bed 10 flagged with “GI bleed.”  I almost bolted to bed 10 to ensure this patient was stable, but then noticed orders pending, so my urgency eased. “I see you already saw the patient in 10,” I began, addressing the triage physician. “Yeah, she’s all set,” he replied, without turning from his computer. ...

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Psychiatry was my first clinical rotation, and I did not know what to expect when I began. When I initially got assigned to the dialectal behavioral therapy (DBT) team, I had no clue what that would entail beyond working with some borderline patients and that the preconception of borderline patients is that they can be “the most difficult” patients to help due to their intense emotional instability, chronic feelings of ...

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I’m looking at a pile of little boy clothes outside my back door this morning. It often looks like this if we forget to clean up. My kids shed their clothes almost as soon as they are home in search of water play of some sort: hose on the slide, sprinklers, water gun fights. They are supposed to put their clothes in the hamper. That obviously doesn’t always happen. This ...

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