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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As a pediatrician I come across lists of “what to ask the pediatrician” and routinely meet with inquiring parents who are in search of a pediatrician.  Occasionally they come with a list of questions but most often they are not sure what they should be asking.  I always tell my new parents that the interview visits can tell you if I’m a normal person and if you can get booked ...

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Have you ever stopped to consider who you are or what defines you? Is your self-worth or self-esteem wrapped up in those two little letters "Dr."? How would you feel if they were removed? Would you know who you are without them? As medical students we work hard, study long hours, sit tons of exams and tests, to ultimately prove we have what it takes -- that we are intelligent enough, to be a ...

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Many of us now have high-deductible health insurance plans, which makes us “cash-pay” patients until we meet our deductibles. According to a Health Affairs health policy brief, high deductible plans are now much more prevalent in both individual and group markets. The higher the deductible, the lower the monthly premium. If you have a high deductible plan and don’t consume much medical care, you are most likely a cash pay ...

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Recently, I was asked to give a talk on spirituality, and it’s importance in health care.  I found myself thinking about how I have spent the last few years focusing on the “easy” fixes with my patients such as diet, sleep, and exercise.  Now, I am not saying that these things are truly easy to fix. However, when it comes to a physician addressing these topics with a patient, talking about ...

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Health care providers are often uncomfortable discussing issues of religion with patients, despite studies that indicate nearly 9 in 10 Americans believe in some sort of spiritual power. As a medical student, I have noticed that religion plays an important role in many patients’ lives, and that conversations about spirituality can build rapport between doctors and patients. As the United States becomes increasingly diverse across religious lines, it is imperative for ...

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A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and ...

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John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain medication and presented to the ER for another “handout” of hydrocodone. He admitted that life was taking its toll, and he was beside himself from aging. Was it time to ...

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Benjamin, Jr. was the apple of their eye. He was cute and inquisitive, and smart. Very, very smart. The minute he took his first breath into this world, his mom and dad had already ordained him as a future MD. He would become a doctor and follow in his father's steps. No questions asked. He would become the second MD in the family. Every birthday, his parties were doctor-themed: kiddie ...

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A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles. But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction. The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their ...

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I find interesting how much lies in the fate of the day's mood when it comes to forming a new patient-physician relationship. I can have one of my typical days (and thankfully this is usually the case) in which my mood is great; I stroll into work, after having sipped an entire cup of coffee, maybe nibbled on a Moroccan cookie or two, and donned my white coat and stethoscope, ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Our institution, like countless others across the country, has been working to institute processes to achieve the “triple aim” of improving the quality of health care, increasing patient satisfaction, and reducing the cost of providing that care. As chair of my anesthesiology department, ...

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This is my 12th year as a physician in the United States. I was born in London, grew up in Berkshire, and decided to become a doctor when I was a teenager. I remember being asked what I thought about the National Health Service (or NHS, the UK’s government-run health system) during my medical school interview. That question is almost a rite of passage for anyone applying to medical school in ...

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Recently, the American Medical Association CEO called digital health care products modern day "snake oil." As a provider and a technologist, I think we need a deeper dive to understand the issues, avoiding the kind of hyperbole that’s so common in politics today. Paul B. Batalden, MD, Senior Fellow, Institute for Healthcare Improvement (IHI), once said "Every system is perfectly designed to get the results it gets." Let’s take ...

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I was standing outside of the patient room with two family members, a faithful wife, and a devoted mother. In the sea of faces that surrounded his bed on a daily basis, these were the two that stood out to me. For this young man in his 30s who was battling metastatic colon cancer, his wife, and his mother were his strongest advocates, constantly seeking answers about his prognosis and ...

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(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.) Dr. Stephen Cluff is like Yoda. Judging by body hair, he's more like Chewbacca. But he's short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet's voice. If I'm stumped on a case, I'll ask him. If I'm pissed off about department politics, I'll call him for advice. If I want ...

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“You’re nothing but a punk ass kid.  And you’ll die a punk ass kid!” With that, she stormed out of the exam room, leaving me sitting on a stool, slamming the door behind her.  Apparently she walked straight up to the front desk and asked to file a complaint about me, but left prior to receiving the paperwork. Most all physicians will immediately know what the interaction involved.  I hadn’t been mean ...

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"It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended." – Joan Didion, Goodbye To All That So it feels at the end of residency. Of course, there is a graduation date. ...

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