This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump.  The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security. He is looking increasingly likely to be nominated by the Republican Party.  Many, however, ...

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These are the words that inspired me to begin my journey as a medical student blogger. Four years later and  I'm still at it!  The time has flown since I received my acceptance letter to now, only a few weeks away from my graduation.  And as graduation approaches and I make the transition from student to resident, I can't help but ask myself, how am I doing?  How is my first patient really doing? It's a difficult question ...

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My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual. Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a ...

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As a primary care physician at one of the nation’s leading academic medical centers I’m still hanging on. Over my 32 years, I’ve seen how my ability to interact with patients has been diminished by an ever-encroaching health care system. There’s a clock keeping track of how much time a patient’s chart is open. I have less than 15 minutes on average to assess my patient’s symptoms and discuss treatment options, ...

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For years, many physicians have complained about the onerous nature of government-certified electronic medical records. However, thanks to the HITECH Act, the rush to digitize medical records has continued. Due to the impetus provided by the ACA and subsequently by MACRA, the mad rush has progressed into a frenzy of data-collecting and reporting activity, all in the name of value over volume. Recently, two objective reports have surfaced demonstrating the futility of ...

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A friend posted an article on her Facebook page discussing a recent research study out of Sweden showing that people on the autism spectrum have a decreased life expectancy. This friend has a child with autism. Autism coupled with learning disability, according to this study, is associated with the largest decrease in life expectancy. This friend’s child has learning disabilities along with autism. My friend is scared. On top of her worries ...

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Dear health care administrator, I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the ...

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Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the ...

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My last post discussed the wide gulf between health care and the rest of the world in the area of customer service.  To sum up what took over 1,000 words to express: Customer service in health care totally sucks because the system promotes that suckiness and does nothing to penalize docs who make people wait, ignore what they say, rush through visits, and over-charge for their care.  We ...

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It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience. This is relatively easy to answer when it comes to health policy. ...

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We are born with arms wide open, and we die in much the same way.  It is that which we carry, in the time between, that defines us. The newborn, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other.  She grasps and roots at inanimate objects with the same voracity she reaches for her mother.  It is a time of differentiation, a time ...

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I just finished reading a very delightful A Piece of My Mind essay in JAMA.  JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is ...

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A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized. My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible and ...

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As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues. As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers ...

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“Son, just let me die.” Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited -- the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and ...

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The consult was for “decreased vision and eye pain.” Inpatient consults at the VA hospital come up infrequently, but when they do, it’s inevitably something interesting. As soon as I access the patient’s medical record, a flashing rectangular box encasing a smattering of phrases such as “warning,” “inappropriate behavior,” and “female employees” pops up on the screen. I’m accompanied by one of our female residents, Dr. Smith. Once we leave ...

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I was never a big prescriber of narcotics.  I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life.  Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin' you ain’t dead yet.” You fell down; it was going to hurt.  You learned not to fall.  Twisted your ankle doing something stupid (and it was always ...

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The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to ...

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Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels.  Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way. In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead ...

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"Beautiful girl, you can do hard things." I saw that quote on my favorite Facebook group recently, called Physician Moms Group (or PMG). This is a group of women who, like all of us, are just trying to “do” life every day. Because of our integrity and intellect, we are trying to do it better than anyone else. I think that’s from a Type A personality, combined with leadership and wanting ...

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