"It's strange how the worst day of your life often starts just like any other." - Joanna Cannon I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned. Twenty years ago on a day like today, I ...

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It’s August. I’m looking out the windows of our log house and across the immense variety of green leaves, on oak and birch, mountain laurel and sycamore, magnolia and honeysuckle. It’s a rain forest here. Indeed, after a long dry spell, we’ve had days and days of soaking rain, with breaks in the clouds so that the sun raises steam from the earth like water coming up in the garden ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as a team is one of the biggest reasons for my practice satisfaction increasing ...

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As a physician and mom, I hate the work culture that generates the glass ceiling for women. Like many professional environments, Medicine is a hierarchical culture dominated by men. The leadership positions are mostly filled by men- including the hospital CEOs, department chairpersons, and medical school deans. This reality begs the question: if nearly half of medical school graduates are women, why don’t we see more female ...

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It is time for me to dig out from under the frustrating quagmire of paperwork imposed on me by my insurance contracts so I can reclaim my sanity and love of my work. I am terminating all of my in-network contracts, firing my billing service, and focusing my clinic time and energy entirely on patient care.  Removing my practice from the control and limitations of health care insurance companies allows ...

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This morning, I diagnosed a 49-year-old female with stage 4 colon cancer. She will probably not be alive in 5 years. She could have possibly prevented this diagnosis if she had known her family history. Many people don't know the health history of their family. This holiday season is a perfect time and opportunity to delve into this history and prevent more senseless deaths. The apple really doesn’t fall too far ...

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The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle.  If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately.  This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically.  Was it something ...

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In a time of rising health care costs, it’s hard to talk about the financial strife of physicians, who as a whole over time do very well financially. We see the bills from our doctor’s office, and it’s hard to imagine why anybody would complain about the upfront investment of a medical education, when the payoff seems so good. Many recent articles make the case for why becoming a physician is ...

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Just a minute before, I had been in surgery checking on the status of a patient who was undergoing an exploratory laparotomy.  She had been doing OK, but deteriorated relatively quickly that afternoon while still in the hospital recuperating from an unrelated operation.  The anesthesiologist popped out of the room to tell me what the initial findings looked like.  It was not good.  That’s when I went to speak to ...

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With Donald Trump’s promise to repeal and replace Obamacare on many Americans’ minds, there are numerous questions about how the health care system will work in the very near future. There are equally as many, if not more, outlandish speculations. Donald Trump was elected a week ago and doesn’t assume office for two more months. Much of what will get changed and how is yet unknown. Yet the mainstream media has been quick ...

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We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse. We always thought we had the higher acuities. We had the critical patients. The multi-system failure patients. The hemodynamically unstable patients. We had to figure out the lungs, the heart, the kidneys, the brain, the pancreas, the gallbladder, the liver. And ...

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A study published in JAMA Dermatology regarding women’s pubic hair grooming practices has people abuzz. This cosmetic act needs a formal medical name because “clamscaping” just doesn’t work on grant applications. Although why the authors couldn’t go with hair removal, I don’t know. The study wasn’t about styling, it was about removal. The study even made it into the New York Times. And yes, my first ...

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Every day, millions of women across the United States find themselves in predicaments confronting the quality of their appearance. And their makeup. While this may seem a non-issue in the emergency medicine world, it is something that you, as a female professional, or that your female colleagues, have no doubt encountered. Before walking out the door, you have to consider not just what means of transport to take to work, but ...

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The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act -- notably the pre-existing condition protections and the ability for children up to the age of 26 to stay on their parents policies. Except this isn’t news. In May, Trump’s policy advisor told Healthline that a ...

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The pain is silent, subtle and gnawing, like that of being overlooked for a promotion, or being rejected by your dream college. Over 60 million Americans who voted for Hillary Clinton may be groping for a way to overcome such a pain after the stunning loss of their presidential candidate. For thousands of years, sages have guided us on how to find comfort in a time of pain ...

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Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather adept at healing his fellow man. The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive ...

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I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing. I may know about your criminal past. I see that tattoo underneath ...

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The election result shook the world. As the vote counts started to come in, most of the country descended into a state of collective shock and disbelief -- even Mr. Trump’s own supporters. Nobody seemed more surprised than the political pundits on all the cable news channels, who had for months incorrectly predicted the opposite result. Let me take a step back for a moment before I sound like somebody who ...

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The Internet revolutionized the way we search for information as well as how we conduct business in our everyday lives. Everything can be purchased online: cars, clothes, groceries, vacation packages. Just about anything. Most people now research products before committing to them, and that now includes health care. It is estimated that 87 percent of adults in the U.S. use the Internet. Approximately 72 percent of Internet users seek health ...

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On November 8, voters in California, Maine, Massachusetts and Nevada approved ballot measures to legalize recreational cannabis. It is now legal in a total of eight states. And this creates potential problems for road safety. How do we determine who’s impaired and who’s not? The effects of alcohol vary based on a person’s size and weight, metabolism rate, related food intake and the type and amount of beverage consumed. Even so, ...

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