As Southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation.  While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base.  They should not identify themselves as “doctors” despite having a doctor of nursing practice (DNP) degree.  It is misleading to patients, as most do not ...

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Holding a small bottle of soap and an even smaller wand, I painstakingly blew air through the small circle toward a shabby window in an even shabbier classroom. Bubbles rose and fell with the rhythms of my breath. I created a long chain of bubbles that eventually took over the room, and the hot and humid Panamanian sunlight dyed it the colors of the rainbow. I was on a medical service ...

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Independent physician groups and solo physicians have been the historic bedrock of medical practice. While it is true that there is intense pressure on the single-physician group, and this market is shrinking, independent physicians are here to stay. Some single practice physician groups may merge with larger groups, some physicians will break off from the large contract groups, but there is no plan on them becoming extinct. Independent physician groups have ...

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A commencement address to the University of Louisville School of Medicine, Class of 2017. It is my great honor to give the commencement address for the UofL SOM class of 2017.  Twenty-eight years ago, I graduated from medical school, and I remember the overwhelming sense of pride and accomplishment in finishing medical school, the relief of never having to study the Krebs cycle again, the excitement of moving to a different city ...

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The opioid overdose epidemic was the centerpiece of U.S. Secretary of Health and Human Services Tom Price, MD’s West Virginia listening tour recently. While the tour was billed as an opportunity to gain knowledge on the epidemic, his response to his observations illustrates just how difficult it is to change attitudes and beliefs with information alone. In response to Herculean state-based and volunteer efforts to keep people alive -- not to ...

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I was recently on an off-service rotation and one morning as I entered a patient’s room that had been admitted to our service, I overheard the patient quickly tell the person they were talking to on the phone, “Hey, can I call you back? My nurse just walked in to talk with me.” For a moment I was confused and actually turned around to look for his nurse behind me. Alas, ...

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I scream in frustration as the flickering screen creates another required check box. Silently of course. I am on the hospital ward, and broadcasting the doctor’s frustration will not help patients or nurses. “Who created this tool?” I wonder for the thousandth time. Why don’t doctors make their own tools? Contemporary philosopher Daniel Dennett ponders thinking tools. “Like all artisans, a blacksmith needs tools, but — ...

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Mr. O was my new patient but had been known to our practice for several years.  He was 74 years old. He had been complaining of “dizziness” for some time.  He came in for his visit accompanied by his home health aide.  He was born in the Dominican Republic, and he spoke Spanish with limited English proficiency.  I scanned his former notes and saw that his aide typically provided translation.  ...

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It happens to us all. I was frustrated with one of my patients about two years ago, angered because she did not want to help herself. She kept requesting help for her mental disorder, and when the help was given, she would literally run away. She would start then stop taking a medication that even she had to admit did help her. Medication was just not for her she would ...

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I'm a medical student. I spend every day of my life considering the well-being of my future patients, and the detrimental impact that various health care policy proposals will have. I'm not going to lie. The ACA has problems. It's not perfect, and I won't wave the flag and pretend it's the greatest thing ever. The reality is that the ACA plans are often cost prohibitive. The lack of a ...

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Amidst the mid-morning rush at clinic, I’m saying goodbye to a patient whose visit just concluded. In the corner of my eye, I see a woman sitting in the area where patients wait after they have gotten their vitals. She is shifting continuously in her seat. Suddenly, the woman springs up out of her chair and walks toward the nurses’ station. The patient I am speaking with remarks, “Oh! Wonder ...

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My nurse practitioner was pleased to see me at my annual physical this year. “So how does it feel to be 20 pounds lighter?” “It feels terrible,” I replied. Allow me to explain. Weight has been an issue my entire life. Raised on a standard Midwest diet of complex carbohydrates and the best processed delicacies that government assistance could buy, I spent most of my childhood socially segregated by my peer group due ...

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Medical school applications can raise big hairy questions about the long-term potential and trajectory of your relationship as well as the question of whether you get a say in where the applicant applies and attends medical school. For some, the timing of these questions arises in synchrony with the relationship’s natural progression that is at a time when you and your partner are beginning to discuss your long-term prospects. Other ...

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When I was in television, I was friends with the late Gene Siskel (the film critic’s syndicated show would shoot in our Chicago CBS studio). Siskel would drop by my office to talk and get free medical advice. Siskel was, you might say, frugal. I remember when I was in contract negotiations with CBS, my bosses couldn’t praise me enough — but the money wasn’t there. When I told Siskel about ...

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The young woman in my clinic, whom I’ll call Nicole, was 8 months pregnant with her third child. It should have been a joyous time -- but she was in a county jail. Nicole was awaiting trial for a misdemeanor, and while a judge had set bail, she couldn’t afford to pay it. I’m a public health researcher and physician in the Los Angeles County Jails, the largest jail system in ...

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Of course, it matters a lot -- hospitals vary enormously on quality of care, and choosing the right hospital can mean the difference between life and death. The problem is that it’s hard for most people to know how to choose. Useful data on patient outcomes remain hard to find, and even though Medicare provides data on patient mortality for select conditions on their Hospital Compare ...

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A transcript of the Loyola Stritch School of Medicine 2017 commencement speech, Saturday, May 20, 2017. Angela Jiang: Good morning! As the class vice president, it is my pleasure to welcome Dr. Pamela Wible to our graduation. Dr. Wible is a family physician and a pioneer in the ideal medical care movement. After completing a family medicine residency and working in different family practices for over ten years, Dr. Wible ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for a 2-year history of cough and a 1-year history of increasing dyspnea. He describes the cough as nonproductive, and his shortness of breath is worse with exertion. He does not have chest pain, orthopnea, paroxysmal nocturnal dyspnea, or any other symptoms. ...

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A few thousand years ago, a talking snake convinced a child to pick a piece of fruit, squeeze it really hard, and drink whatever came out. The kid liked it, obviously, because what’s not to like about juice? So the next day at preschool, he told all his friends to ask their parents for juice, too. Some of them said the magic word; others just whined until their parents gave ...

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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments. While we are a very busy practice, and this is not ...

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