As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future. I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and ...

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Which arrow causes you more pain, the first or the second? Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering. It reminded me of a Buddhist teaching that inspires and humbles me. Blogger and curator extraordinaire Maria Popova quotes it in an article she wrote last year on a book by Tara ...

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I'm looking forward to seeing you for my fall 2017 speaking appearances.  I'm currently considering opportunities in 2018.  Please visit my speaking page for more information.

This is a letter to everyone who has ever smiled, shrugged their shoulders, or nodded while either hesitantly or enthusiastically uttering the words, “Yes,” “Sure,” “OK,” “I guess so,” or, “Of course,” when a medical student has asked if he or she can talk to and examine you before your doctor comes in. We know that you are busy and that your time has value. We know that you have ...

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As a pediatrician in training, I’ve seen countless instances in which parents, in both the ED and inpatient/outpatient care settings, have presented with deep concern regarding their child’s fever. It’s an age-old concern. But why exactly does fever cause so much distress in a parent’s world? As a medical student, I distinctly remember rotating with an attending physician who had strong feelings regarding fever. He became angry with me when I ...

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I am not a doctor.  (Yet.)  I am a novice third-year medical student, somewhat able to perform and document a physical exam on a sleeping child, to dial the correct number to call a consult and to make wild guesses about chest X-rays (“I see a consolidation?”). I write about medicine not from a position of experience, but of malleability.  I want to become like the best doctors I see. Towards ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old man is evaluated for fever, dysuria, and urinary frequency of 1 day's duration. He also notes a sensation of deep pelvic pain near the rectum. He has no urethral discharge or testicular pain. He states that he felt well before the current illness and has ...

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In a terrible twist of fate, the very day that the Centers for Medicare & Medicaid Services (CMS) Hospice Compare website went live, I found myself in a pulmonologist’s office with my parents, taking in the news of my mother’s advanced cancer and malignant pleural effusion. The shock of it, and the uncanny timing are beyond comprehension. You see, I’ve been leading research at RTI International and ...

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Anyone entering medical training is taught that medicine is an art, one that combines scientific knowledge, discovery and application with its practice. It is both art and applied science. It should never become nor has it ever been only all one or the other. To be medicine at all, the noble vocation that so many brilliant minds sacrifice to pursue in service to their fellow humans, the practice must balance art ...

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Well, it’s that time of year again. Fall is near, and ‘tis this season for more pay cuts from CMS and insurance companies. Are there any other health-related professions that receive across the board pay cuts? I know of none. The U.S. health care mega-complex includes not only physicians, but hospital administrators, legions of hospital vice-presidents, insurance company executives, elected politicians, federal employees at CMS, hospital employees, pharmacists, nurse practitioners, physician ...

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My significant other is a physician working in Houston, and he missed Hurricane Harvey over the weekend, being out of town for a conference. The hospital sent out an S.O.S. asking faculty to do their best to come in. As the Houston airports continued to be closed Monday and Tuesday, he and his colleague, also a physician and a native of Houston, flew to another airport and drove a few ...

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Imagine driving through an unfamiliar area, and there are no street signs. How would you feel? Frustrated? Scared? Angry? You would feel these emotions because you had no direction or guidance. Patients need direction when they enter the health care system. Signposting is a tool to provide direction. On the streets, there are posts that have signs. They provide direction; they tell us where we are going. Hence, the name, “signposting.” ...

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This article was originally presented as student remarks at the 2015 Harvard Medical School commencement.  At the end of medical school, I always return to a musing, a zen koan of sorts from Dean Jeffrey Flier. At my white coat ceremony, a close friend and current resident, Dr. Nina Gold was chatting with the dean about the heft of our newly bestowed bright white coats. He asked her, in one beautiful ...

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Being a health care provider has always come with personal risk. We care for all patients, which includes patients agitated due to psychiatric issues, dementia, acute medical illness, alcohol or drug intoxication or just anger. Patients can be extremely volatile and lash out unexpectedly causing physical injury to their doctor, nurse or another provider. Besides the physical risk, patients can be emotionally and verbally abusive as well- and both types ...

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For American conservatives, Britain’s NHS is an antiquated Orwellian dystopia. For Brits, even those who don’t love the NHS, American conservatives are better suited to spaghetti westerns, such as Fistful of Dollars, than reality. The twain are unlikely to meet after the recent press surrounding Charlie Gard, the infant, now deceased, with a rare, fatal mitochondrial disorder in which mitochondrial DNA is depleted — mitochondrial depletion disorder (MDD). In this condition, ...

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“You’re a doctor; focus on being a doctor.” This piece of advice was recently given to me by my own father, in regards to my multiple ambitions outside of the medical field. He himself only recently retired from a long career as a surgeon, so his opinion is the result of years of experience. His advice got me thinking. What makes for career longevity in our field? Statistics show that more than half ...

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More than anything, Willie needed a place to pee. Elaine needed help walking. Willie is homeless; Elaine is affluent.  They both needed someone to listen to them and help them find solutions to their most pressing everyday challenges.  That’s called “co-production of care.” When Willie found out he had congestive heart failure, his doctor put him on beta blockers with diuretics. The medications made Willie feel better, but there was one problem:  Because of ...

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In the early epoch of human development, mankind learned to shape and sharpen wood, stone and metal objects to facilitate plunging them deep into other humans’ chests, abdomens, skulls and eyes in the ultimate form of conflict resolution. Over tens of thousands of years, other less pugilistic and more compassionate humans crudely — but later artfully — insinuated an increasingly sophisticated array of implements into the human corpus to cure diseases, ...

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Part of a series. Can we slow the aging process? The answer is a definite yes. It’s not easy and requires some real diligence, but aging can be slowed. When thinking about a car we all know “old parts were out.” It is equally true for the human body. But less appreciated is the fact that we can either slow or speed up the process, just as good preventive ...

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A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined. The mainstream media converged towards numerical consensus.

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