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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Behind every door in my clinic, is human suffering.  It hangs like a mist; I can see the living ghosts of my patients through it. As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting.  I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics:  a ...

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Dear Hippocrates, I want a divorce. Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were perfect for each other: valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in ...

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recent research paper from the University of Virginia may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as "organic" or "psychiatric."  UVA researchers have discovered a complex network of lymphatic vessels which service the brain, prompting a serious update of the concept of a highly selective “blood-brain barrier.” When asked about methods to study the immune response of the brain and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique ...

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She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have. Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days.. And finally said their ...

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Sometimes, I wish I was a nurse. As a nurse, my work-life balance would greatly improve because my three 12-hour shifts would constitute a rewarding and flexible full-time medical career. I would care for all kinds of patients, not just stick to one medical specialty. Maybe I’d go for an advanced nursing degree; I would enroll in school full-time and also maintain a paid full-time job. Like many nurses, my hospital ...

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A few years ago, I missed a diagnosis.  I know that’s not earth-shattering, but the stakes are high for a cardiologist.  Ms. A was an 82-year-old woman with chest pain. She underwent a transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.  The pre-procedure coronary angiogram showed no coronary artery disease and the echocardiogram post TAVR was perfect. However, a few months after the procedure, she reported arm pain.  It was ...

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We were the consummate lovebirds. We studied together, exercised together, and went grocery shopping together. When she started medical school, I took a summer job in the school’s maintenance department, just so we could eat lunch together. We couldn’t fathom being separated an entire day. It was a magical time. We worked hard, played hard, and talked late into the night -- yet rose early the next morning, energized and ready to go. ...

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Born in Canada, our mother came to the United States after World War II and blended into the Greatest Generation. Raising a family in the second half of the 20th century saw her contribute to a thriving American society then maintain retirement health on Medicare. But in her early 90s, this tranquility was threatened when her HMO hospital tried to kill her. She went to the emergency room with symptoms of ...

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As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients' desires for convenience in ways that many traditional primary care practices do not. A report by the Robert Wood Johnson Foundation found that retail clinics have increased by 900 percent over the last decade, an expansion ...

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To those of you who are still in the midst of  pursuing a seemingly elusive goal of being in medical school I highly encourage you to take a few moments and jot down why you want it so badly.  Make a quick list of all the reasons why you want to be a doctor and how you will feel once you achieve that monumental goal.  For those of us in ...

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My thoughts settled on the Frank Sinatra song, "My Way," when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings.  We closed the office that Friday to allow three full days to get settled.  However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck. “All we need is a stethoscope, ...

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I was afraid.  Really, I was more anxious.  This wasn’t any of the typical new mother fears I had been warned about. If fact, I didn’t even see this one coming.  I knew that it would be tough going back to work 3 months after my first daughter was born.  I knew I would miss her terribly.  I knew I had to figure out a pumping schedule with my colleagues ...

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Can you trust online physician ratings? Many people believe you can. But here’s what a recent article in the Harvard Business Review (HBR) about the reliability of online user ratings regarding buying a product. The authors concluded that online ratings were generally not to be trusted for three important reasons:

  1. The reviews are usually based on a small sample of users. The authors said, “We can be more confident ...

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