This past summer an article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients, so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just, and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, ...

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A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine. The marvel of medicine today is that we can treat all three infections, and save the lives ...

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In neurology clinic, I was asked to see a young man with epilepsy -- a seizure disorder -- due to cerebral palsy from birth. It was one of my first clinical encounters of my first rotation of medical school, the tenuous transition from knowledge-absorber to translator and caretaker. I walked in to find a patient who was wheelchair-bound and largely non-verbal, and who interacted with the world by tracking gaze ...

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Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long. Surgeon and writer, Atul Gawande, explores the medicalization of ageing and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and ...

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"Hey, Rick. They warned you about me, I hope?" My routine med student opening line elicits a slight smile from my balding forty-two-year-old patient and the patient's wife. As we shake hands, I continue the script. "I'm Nat -- the medical student. What brings you in today?" "Well, I'd like to transfer my care to this clinic. We've brought my medical records." Together, they heave stacks of papers onto the desk. Rick's hands slide ...

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comicfinal In 2006, graduate nursing programs started granting doctorates of nursing practice (DNP degrees). In a media fact sheet, the American Association of Colleges of Nursing (AACN) explains the thrust for the change this way:

Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of ...

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A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part ...

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Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes. It is common practice to leave a permanent tattoo at ...

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I woke up to someone forwarding this tweet. Yes, some company is selling tiny bags of herbs (they call them pearls) to stuff in the vagina for three days to cleanse your uterus or shrink your fibroids or treat bacterial vaginosis or tighten your vagina. This is not only pointless it could be very dangerous. Here’s why. Your uterus and vagina want you to leave them alone. Your uterus isn’t tired or ...

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asco-logo I run a dilator program for women with rectal or anal cancer where I educate patients about the need for and correct use of vaginal dilators to mitigate the effects of radiation on the vaginal wall. Many women don’t understand the need for dilators after radiation for this cancer, so I always start with a description of the anatomy and ...

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Picture this: You’re in the operating room, performing a challenging procedure. (If you’re not a doctor, roll with me here and play along. You’ll get it soon.) You’re feeling pretty good about how the surgery is going. You’re grateful that your usual team is with you, because that always makes you feel more confident. Then something happens … Right at the most critical part of the procedure, crisis ensues and the instrument you’re using ...

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In the fall of 1980, in my final year of medical school, I sat in the main ward of Saint Vincent’s Hospital, Greenwich Village, Manhattan. Filling the vast space were twenty-four beds, in four rows, with twenty-four patients. The prow of the open nursing station thrust from one wall into the center. A high ceiling vanished above. Yellow light filtered through ancient rippled glass windows and distant fluorescent bulbs made ...

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This past month has been a particularly difficult one for me because I’ve been on our float rotation. I have worked only night and swing shifts throughout our hospitals; this means my work hours are primarily from 8 p.m. to 10 a.m. There are certainly other rotations during which I worked longer hours and had more emotionally draining conversations, but I have never felt as burned out as I have this ...

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A guest column by the American College of Physicians, exclusive to KevinMD.com. The election year has finally arrived. Even though the candidates have been on the trail for what seems like forever, I wanted to wait until the traditional time to announce the launch of my campaign. Don’t worry, I’m not running for office. My campaign is an initiative to get us to start talking about the “quadruple aim” ...

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After a stressful morning, a physician colleague receives a note from her 4 year old that read, “MOMYOUFORGOTTOGIVEMEAKISSTODAY” in classic large, space less toddler scrawl. She shared it knowing that other physician mommies can relate. We’ve all been there. The heartbreak that is a part of life as a physician mommy takes many forms. Whether a pout, a stare, a cry, a comment, a scowl or a note, no one can ...

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Post-apocalyptic portrayals of medical school. Depressive symptoms in 43.2 percent of resident physicians. 34.1 percent of medical students experience burnout by third year, and that percentage increases during residency, ranging from 41 percent to 74 percent by specialty. We lose hundreds of doctors each year to suicide, at a rate that is twice as high as the national average. Burnout increases the risk that a physician will make a mistake, which ...

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2015 was a year to regroup and reassess my professional goals.  Immediately after residency, I did as most physicians do -- apply and hope to get a job that pays well and is in a good location.  Similar to the personalities of most physicians, I am a workaholic and overachiever.  Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my ...

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"What is your personal experience with human suffering?" he asked. Fellowship interview season. Interviewing for pulmonary and critical care, one may expect such a question. I thought I was ready for it. But the simple truth is that I didn't really have the right answer; I probably never will. During the morning rounds, my attending physician heaved a weary sigh: "150,000 people die every day!" Out of the blue. I quizzingly ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin. On physical examination temperature is 36.7 °C ...

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The metallic mix of freshly spilled blood and sterile instruments engulfed his nostrils as he shifted uncomfortably in the cracked, worn, brown leather chair where so many others had sat before him. He tried not to sweat as the faceless, gray clinician coaxed the long needle deeper into his fleshy neck and watched as a rogue drop of crimson escaped and marred the otherwise pristine tile floor beneath him. He ...

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