Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.” Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream. Can I see a show of hands, please? That part of us, the one that strives ...

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Replacing transcriptionists with physicians is a fools bargain My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions. The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If ...

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A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the ...

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It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; ...

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How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between? I frequently speak with large audiences, ranging from CEOs to Stanford business school students. I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do ...

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The world is asunder.  Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping ...

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FiveThirtyEight had a provocative article: "Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much." The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have ...

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I flunk as a parent. I have no plans for my youngest kids this summer. The older ones are working. But the 13-year-old and 8-year-old, the ones at the formative stages of their academic and skill development (if you believe what everyone says), are doing squat. No camp. No enriching activities. No special trips. Well, we do rent a house at the beach for two weeks every summer, that's something, but ...

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Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened.  After three years of treatment for cancer, she is in trouble.   Kasey feels fine: no shortness of breath, no cough, no pain.  Still, she is there to get the report on her CT scan, and she knows ...

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We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long ...

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My path to medicine is tied to my family’s experience with poverty, and with the profound economic fallout a major illness can bring in such circumstances. I grew up on the Couer d’Alene reservation in Northern Idaho. My mother was a single parent who had to rely on government assistance to raise three children in subsidized housing. As the eldest, I was expected to help care for my younger siblings ...

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If you put ten physicians in a room, you will get nine different opinions.  It doesn't matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of ...

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The interview had lasted fifteen minutes so far, and we'd made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora's medical history together. A year earlier, Leora, in her mid-fifties, ...

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Stop calling nurse practitioners mid level providers I really hate it when a nurse practitioner is called a mid-level provider. "Mid-level provider" isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD. The term "mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and mid-wives. It is insulting to health professionals ...

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My heart sinks each time I see the subject line in this too common email I receive in my medical practice: “Sad news: Matthew was fine when he went to bed last night but his mother found him dead in bed this morning.” Matthew (not his real name) had epilepsy with seizures that persisted despite use of currently available antiseizure medications. We started Matthew’s evaluation when the latest antiseizure medication had been ...

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In just a few days I’ll be leaving the clinic where I’ve practiced pediatrics for the past six years. The last months have been a flurry of last visits with families, paperwork, and tying up loose ends. There have been many, many goodbyes. I’ve been deeply moved by the expressions of gratitude and affection that many families have shared with me. It seems it is always in these times of change ...

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I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best ...

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In 2011, Food and Drug Administration Commissioner Margaret Hamburg remarked upon a “new direction in the treatment of hepatitis C,” as a success rate of approximately 70% marked a significant improvement over the previous rate of approximately 50%, and suggested a cure was in sight. Today, that cure has been realized as Sovaldi (sofosbuvir), a novel agent, has shown a success rate of 95% in clinical trials.  Sofosbuvir comes without the ...

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The VA scandal over excessive waits for doctors’ appointments is an early warning of things to come. Over the last three years, the demand for primary care appointments at the VA increased by 50% while the number of providers rose by only 9%. With four hundred vacancies for primary care providers, the VA is facing a severe gap in its ability to care for its patients. It isn’t surprising that the ...

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When I started medical school, a wise professor likened the amount of new information I was about to learn to trying to drink water from a fire hose.  It didn’t take long until I understood exactly what he meant.  After sitting through the seemingly endless hours of lecture, lab and small group sessions required in the first two years of medical school, my head was spinning from information overload.  The ...

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