"I'm going to the doctor next week for my yearly physical." So normal. Of course you are. Everyone should do that. But the concept of a yearly examination of one's whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question. I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at ...

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Let me preface this blog by stating that I write this to stimulate discussion and debate, not to sway opinions. Today, doctors are required to spend more and more time doing administrative work -- including checking off electronic boxes in the electronic medical record (EMR) -- the result is less quality time with patients. Now, those that are in Washington, DC think that requiring physicians to ask about guns in the home ...

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The latest celebrity to use the internet like a a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down. But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office ...

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I was called at 4:30 a.m. for a patient with tachycardia in the hospital, and as I logged into my EMR from home, I saw this on Twitter: https://twitter.com/EM_Educator/status/759297946160656384?ref_src=twsrc%5Etfw In under two hours, there were 15 retweets, 44 "likes," and 19 comments that appeared on Twitter (so far), most wishing the patient the best, looking forward to pictures of the angiogram, etc. This is the lovely world of social media, but it also demonstrates his ...

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Even the most honest among us do not tell the truth all of the time.  We are flawed human beings.  We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal?   Have you ever "borrowed" someone else’s idea and represented it as your own? A few weeks before I penned this, I was presented with two opportunities to lie in order to save a ...

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Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce. The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really -- if you had it). This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for ...

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Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” ...

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We have a vaccine crisis in the this country. Not just the one caused by anti-vaxxers like Jenny McCarthy, scaring Americans away from life-saving childhood vaccines with pseudo-scientific claims about autism. Instead, I’m talking about a bigger crisis, one caused by a dangerously thin supply of vaccines. Wise parents who ignore the blatherings of people like McCarthy may soon arrive at their pediatricians’ offices prepared to vaccinate their children, only ...

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“Please don’t cut off my pants,” he pleaded. “I am homeless, and they are my only pants. Please.” He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life-threatening injuries as a level 1 trauma activation. Based on the location of ...

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My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within. Often, when what a patient is saying doesn’t make sense, or it is ...

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To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers. Case 1: Downgrading caviar to boiled salmon A patient was referred for a CT angiogram run ...

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I can't believe I'm writing something with this title. Anyone who knows me and sees my name next to that title will probably spit their coffee all over the kitchen counter. And to all the people who have dealt with me on call, let me begin by saying, I'm truly sorry for anything I might have said, done, thrown or broken. Mostly. Kinda mostly. Those who know me will likely think ...

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Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them.  Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are ...

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StephanieFired Dear Pamela, You’ll never guess what happened to me today. Hours after the National Day of Solidarity to Prevent Physician Suicide volunteer web page went live, I received an email stating that I am officially terminated from my psychiatry residency program. On this web page, I spoke about the fact that I had become interested in this event during my struggle to ...

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Dear Class of 2020, You’ve worked hard to earn the privilege of becoming a physician. I hope you took some time before starting medical school to enjoy yourself and embrace your passions, be they travel, music or art, or simply spending time with family and friends. Becoming a doctor is a long, bumpy and often lonely road. Resiliency is essential. My first and most important piece of advice is to be ...

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"Why do you want to go into family medicine?" my internal medicine preceptor asked. It was an innocent enough question. I'd known from day one of medical school what I wanted to do, so I answered with confidence, and perhaps a bit of a chip on my shoulder. "I love being with people and getting to know them," I said. "I've always been this way, so it makes sense that's what I ...

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Somehow people knew he was about to enter the room. The thirty or so people in the room were seated, though people began to stand up. “Are we supposed to stand up for the surgeon general?” I asked the person sitting next to me. She shrugged. If we remained seated, everyone would have noticed. So we stood up. “I’ve been in this position for a year and a half,” Dr. Murthy ...

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“Please don’t spoil the movie with your own soundtrack.” Remember hearing this message before the beginning of a movie in a theater and how most people turn their devices on silent to watch the movie? The cost of the movie ticket is considerably less than the cost of medical education, but I wonder if learners consider this phenomenon when they walk into their classrooms. Is the habit of smartphones in ...

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Being a doctor is often more about talking to people and communicating than it is about the scientific practice of medicine. This is something that is unfortunately not taught in medical school, and it’s left to newly qualified doctors to realize very quickly as they start their careers. Throughout the busy and hectic day of any hospital-based physician -- no matter what their specialty -- one of the most common requests ...

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I have been a rehabilitation specialist and case manager working with patients who have neurological and neuropsychiatric impairments for thirty years. About three years ago, my life took an unanticipated detour when I was perforated during a baseline colonoscopy. All of my experience as a case manger and patient advocate could not prevent this error or the others that followed. Although my health, body, and life were forever altered by the ...

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