Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won't be able to handle something. Sometimes I feel afraid of the unknown ...

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And if they can, should they? In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices ...

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Most of you know me -- if you know me at all -- as a pediatrician. But I’m a parent, too, just like you. I have three fantastic girls that I love dearly. Let’s talk. My first daughter was born before I knew anything about medicine. She has taught me more than I could have imagined. I’ve watched as she has grown from a tiny and helpless infant ...

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Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium ...

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Pacing refers to spacing out your activities during the day so that you’re able to stay within the limits of what your body can handle without exacerbating your symptoms. Another way to think of it is that pacing is a way to keep you inside your “energy envelope” -- the envelope that contains your energy stores for any given day. First, an admission: Even though pacing may be the single best ...

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Election Day 2016 should have been Christmas morning for Republicans. Long awaited control of the White House and both houses of Congress. A chance to deliver on an every two-year election cycle promise to repeal and replace Obamacare. In 2010 Republicans needed the House. They got it. In 2014, it was the Senate. Delivered. But we still need the White House they said. Asked and answered with President Donald Trump. So, ...

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The return from a vacation weighed on me physically.  This had been a true vacation -- an entire week away from clinic and spent with my family.  I even managed to unplug to the point of only checking email on my phone twice per day -- really! The tension that years ago took up permanent residence in my shoulders had faded away without my noticing, so that when I awoke to ...

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The emergency room is packed. I interject another question to further clarify when exactly Mrs. Smith’s chest pain started, cutting off a story about her daughter -- a tactic I would have found unthinkably rude only years before but has now become a necessary technique. After leaving the room, I try to put in orders, but the electronic medical record resets itself, I’m informed an X-ray won’t upload unless I ...

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It’s no secret that health care is an unbelievably complex subject. One of the most complex issues facing the health care system is that of surprise medical bills. Surprise medical bills happen when:

  • Patients receive emergency care by an out-of-network provider (one not included in their insurance plan);
  • Patients are unaware that one or more of the providers of their non-emergent care were out-of-network; and
  • Patients choose out-of-network care without ...

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I’m convinced this will be a year of reflection for our family  --  as we’ve witnessed so many transitions in the past year I find myself deep in thought. As I reflect, I’m full of appreciation for the journey we’re on. I’m full of gratitude for so many of the people who have helped us along the way  --  especially the amazing doctors who have become like family.  This past ...

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A few weeks ago, before the demise of the American Health Care Act, President Trump sat down for an interview with Tucker Carlson at Fox News. Citing an article from Bloomberg, Carlson informed the president that the counties which voted for him “would do far less well under the bill than counties that voted for Hillary,” were it to pass. Whether intentional or not, Trump agreed with his assessment, noting ...

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Recently, another local family buried their young adult child due to a drug overdose.  Sadly, this same story is playing out daily across the nation. Upon reading the headline, I paused to think about an encounter leaving work one Friday evening. As I was walking in the dimly lit street to my car, I found a small group of shadows huddled over something lying in the adjacent alley. Once closer, I saw that ...

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And I don’t love it. When I gained acceptance into medical school, I thought I would one day have one amazing job, or at least one job title where I might get to wear several meaningful hats. I’m a physician anesthesiologist. It’s my duty to play a role in improving the health and the lives of my patients. I studied and trained for many years to have the privilege of understanding the ...

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During breakfast with my father over the holidays, a friend of his asked me what kind of doctor I am. “I’m a radiologist,” I answered. I was met with a puzzled expression and a reply of “Oh, I thought you were a doctor doctor.” I smiled and returned to my banana. Most radiologists, especially those like me who are not physician offspring, are faced with this sort of discourse at least once. ...

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In the market for a locum tenens position? If you search online "How to book a locum assignment?" you'll likely find vague advice such as "Develop a relationship with a recruiter." Or "Do your homework when choosing an agency." Thanks, Internet ... Having worked as a locum tenens recruiter for over 15 years, I have seen consistent trends in how the best clinicians are able to stand out and book jobs. ...

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I have now been out of the active medicine for two years. I still have dreams about being a doctor and practice. I don't think you can do the same thing day in and day out for 40 years and not have it be a part of who you are. I am still asked my opinion by friends and family about their health issues, and frankly, I find my fund ...

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Ya mero llegamos?” Are we almost there? These become one of the most dreaded words I have to hear every weekend, when I pick you up from the long commute that is from Sacramento to the bay area to spend time with you. Oftentimes I am just as inpatient as you my love. This has been our sacrifice these last few years, being physically away from one another. I take a deep ...

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Are you a medical resident or fellow?  Do you have a family to provide for?  Do you feel that your biweekly paycheck is not quite enough to justify the hard work you put in?  Luckily for you, your program offers the great benefit of "moonlighting."  Should you take advantage?  Here are some of my thoughts on the matter. What is moonlighting? Like so many other things we take for granted in medicine, ...

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The average amount of time it takes someone to become a physician is approximately 11 years, and for those pursuing further specialization, one can easily add a couple of years to that. The time certainly adds up by investing years in college, medical school, residency, and fellowship. By the time I will be an independently practicing cardiologist, I would have invested about 16 years into my training. That’s almost half ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker. On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable. An initial ...

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