maxresdefault Sir William Osler (1849-1919) is universally considered the father of modern medicine. “He belongs to medical students of all time, as Lincoln belongs to the common man everywhere.” - Wilder Penfield, eminent Canadian neurosurgeon, who met Osler while at Oxford “His energy, productivity, and humanity blossomed out of a deep vulnerability. Between the pages of his books, we can still encounter an Osler who is … ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his weight. Medical history is significant for prediabetes and elevated cholesterol levels. He smokes one or two cigars a week. He drinks one or two alcoholic beverages a few nights each week. He does not get ...

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Burnout-640x400 Physician burnout is the latest trend among doctors. There are books, workshops, even special breathing exercises for physician burnout. Suddenly every other doctor I meet has burnout. And half of all med students have burnout before they graduate. WTF. We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these amazing people get so screwed up ...

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shutterstock_146497481 Genomics and its impact on clinical medicine appear to be the topics du jour. The science is rapidly advancing, but our ability to understand and apply that science may not be keeping pace. The question is whether expectations will meet the promise, and are we wise enough to navigate the maelstrom and bring true benefit to our patients and consumers in general? Three ...

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It was two years ago.  It was a rough morning and I felt defeated.  I stood by the next patient’s doorway.  I couldn’t see myself, but I knew my own appearance: head down, a look of resignation, shoulders slumped.  I knocked on the patient’s door and entered.  “Good morning!” I said to the patient.  I felt my energy levels depleting in the effort to remain upbeat and enthused.  The tank ...

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What do EMTs do in between calls?  Talented folks, those first responders.

shutterstock_70019551 Sometimes I’m not the nicest. Sometimes I don’t say “thank you” or “please.” Sometimes I seem gruff or insensitive. Sometimes my tone does not put you at ease. It’s not because I disrespect you. I value our interactions each and every day. It’s not because I don’t like you. Some of it is just the way I was trained. You are at the bedside ...

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For two years, I served as a representative to my medical school's student affairs committee.  My job was to convey medical student concerns and problems.  As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress. Two recent articles have led me to write about the issue now: "10 simple solutions to stop medical student suicide," ...

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From every direction, the practice of medicine in the U.S. is under attack. If one were to believe the headlines, the American health care system is populated by insensitive, selfie-shooting, Medicare/Medicaid-cheating, inefficient, and ineffective physicians grappling with an over-regulating government, predatory insurance companies more concerned about profits than the health of their customers, and a legal system that more often confuses a bad medical outcome with actual malpractice.  Morale in ...

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shutterstock_223842769 There are two key scenarios when doctors fail to tell “the whole truth and nothing but the truth so help me God.” Sometimes doctors give a diagnosis we’re not 100 percent sure of and other times we don’t diagnose something we’re almost 100 percent sure of. The truth is complicated and often more gray than black and white. Scenario #1: “You have [insert diagnosis ...

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When we take our sick or injured loved ones to the hospital, we often hope that they will be admitted. In many instances, this is a very reasonable request. When heart or lung disease are at work, when severe infections, dehydration, fractures or strokes occur, admission may well be the only option. However, sometimes our desire to admit our family members is a throwback to a simpler time in medicine; ...

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Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully ...

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A few months ago, I was wrapping up a lengthy consultation, when my patient pulled out three pages of an "ask your plastic surgeon" questions she’d found on Google. I had other patients waiting, so I was about to direct her to my staff, when she posed this question: “Would you do surgery on a member of your family?” What a strange must-ask question, I thought. “No,” I said aloud. “Not major ...

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shutterstock_110328875 Time was baffling. It seemed like just yesterday; I sat in a posh auditorium in Chicago as an enthusiastic young adult during my first day of medical school orientation at Northwestern in 1995. Eighteen years later I was a forty-three-year-old burned out physician, practicing in Boise, Idaho, doing Google searches on the most effective way to end my life. During my time ...

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There was a doctor. The doctor had an office. In the office, he had a practice. The doctor worked hard, was honest, smart and compassionate. He took care of many patients, everyday, and helped many people. The people paid with cents, checks, and chickens. He was solo, alone, by himself. It was good. There was a hospital, near the doctor. It was an important hospital. It took care of many patients, ...

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Being sick and hospitalized in a lonely and unfamiliar place is a terrifying time for our patients. It’s an easy thing for doctors and nurses to forget as we go about our hectic days, when time goes by so quickly that we barely have time to stop and think. Whether you are practicing medicine in a large academic center or a small rural hospital, the feedback that patients give about ...

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shutterstock_175398194 american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I often hear patients say, “I am not afraid of the surgery, just the anesthesia.” But should patients worry?   Physician anesthesiologists suffered a crisis in confidence in 1982 when the ABC television program 20/20 aired, “The Deep Sleep:  6,000 ...

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asco-logoI’m sure I am not alone in saying that I am almost obsessively conscious of time. Namely, that there never seems to be enough of it. As busy oncologists, we all have constant demands on our time, from our leadership, colleagues, drug company reps, insurers, and our families, not to mention the time we try to carve out for ourselves. But ...

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I watched helplessly as a dear friend went through the emotional meat grinder of a new cancer diagnosis. Her husband was found to have melanoma on a recent skin biopsy, and she knew that this was a dangerous disease. Because she is exceptionally intelligent and diligent, she set out to optimize his outcome with good information and the best care possible. Without much help from me, she located the finest ...

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The history of American medicine is the story of the rise and fall of a professional guild.  In the 19th and early 20th centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice.  Even more important, medical ethics put the patient first, above considerations of personal gain or even collective social goods.  The medical guild may have been insular, self-protectively territorial and ...

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