The year was 1976. I was graduating from a small branch of my state university with a bachelor's in chemistry when I first applied to medical school. I was living at home and paying my own tuition. There were no physicians in my family, but I became interested in medicine after I was impressed with a surgeon who had operated on my shoulder. I had a better-than-the-medical-school-acceptance-rate average on my ...

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An excerpt from Five Moments: Short Works of Fiction. “Dad ... you can let go now.” Thomas heard his daughter’s voice from a distance. It awakened him from his reverie. He relived those five moments of life and took their lessons seriously.

  1. Rejoice in the ordinary as if you were a child seeing everything ...

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(This letter was jointly written by members of the American Association of Women Emergency Physicians.) We are writing to condemn James Green’s letter “Equal Pay for Women has Consequences” in which he suggested women be paid less than men as a matter of “simple economics.” This letter is heavily laden with bias against both women and men. The assumption that men need to ...

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To my beloved patients and your families, Over the years, it has been an incredible experience and honor to be allowed to enter into your world. It is a world that I know few people are privy to, and it is an intimate world where the deepest questions about life tend to arise. I know that when you are confronted with sickness that leads you into this world, it can be ...

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After writing about the coming demise of the Affordable Care Act, I began to think, again, about why it costs so much to deliver health care in this country. If it were cheaper, legislation to make health care a right, rather than the randomly distributed privilege it is now, would be so much easier. Medical costs doubled every decade from 1960 through 2000. This happened in tandem ...

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A month into Donald Trump’s presidency, it is clear we are in for a wild and dizzying ride.  As is typical in matters of opinion, post-mortem analyses on how we got here are frequent and varied. However, I believe the Affordable Care Act was the iceberg which sunk Hillary Clinton’s ship.  Sure, there were both real and fabricated scandals which dampened enthusiasm among potential Clinton voters.  There were the emails.  There ...

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A report in the Journal of the American Medical Association (JAMA) shows that too few women with recently diagnosed breast cancer and at high risk of a BRCA genetic mutation received appropriate genetic counseling. And that testing for the mutation is a missed opportunity not only to improve treatment for these patients but also to prevent some breast,
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Leaving your career in medicine is like breaking up in a long term relationship. It may have all started out with lofty expectations, excitement about the future, and becoming your best self. However, somewhere along the way, things got messy and twisted and not what you signed up for. There were hiccups along the way, signs that maybe it wasn’t good for you. There was the time you fell asleep at ...

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The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, cholesterol levels, fasting glucose and urine protein. We discussed bowel and prostate cancer screening in detail, and I gave him written information as we were out of time. As I signed his script for the blood pressure medication, he winked. “That was easy money for you, wasn’t it?” Thirty-seven dollars and five cents is the value the government places ...

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I have only been able to make it back to my hometown once a year for many years now, but I recall my father having a very friendly dog many years back, a black Labrador mix named Abby. She was well behaved, would stay in the yard if you let her outside, didn’t cause problems, and was great with children. Then about ten years ago, another dog was added to the ...

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With thousands of cancers, thousands of families and thousands of deaths, I came to see deep time. I absorbed the finite nature of existence and gained a long view. Not just yesterday’s tests, today’s battle and tomorrow’s treatment, but the loss to come. I do not know when the reaper will arrive, but understand he will. I mourn each patient before we meet. I have learned not to cry. Call it ...

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If I have to hear, "There is always a third victim in these situations, don't forget to take care of yourself," one more time, I may go crazy. I wish people would be cognizant of the language they use. According to the dictionary, a victim is, "a person who suffers from a destructive or injurious action or agency." Don't call me a victim. I go home afterwards, completely broken by what just ...

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Dear Dr. Wible, I want to fill you in on what really goes on behind the scenes at my medical school and maybe you can help inform other students about what happens here before they make a huge mistake. If students slip through the cracks of a U.S. medical school, then international med schools in the Caribbean may be the next choice. Some have better residency match rates than others so ...

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It won't work. Obamacare works for the poorest that have affordable health insurance because all of the program's subsidies tilt in their favor. Obamacare doesn't work well for the working and middle class who get much less support -- particularly those who earn more than 400 percent of the federal poverty level, who constitute 40 percent of the population and don't get any help. Because so many don't do well under the law, ...

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Among surgeons, it’s pretty common knowledge that residents and other providers may perform non-critical parts of a patient’s procedure. This not only helps residents and other trainees gain valuable surgical experience, it also gives patients better and faster access to high-demand surgical expertise. The question is this: How well are surgeons explaining these facts to their patients? Recent guideline updates by the American College of Surgeons (ACS) underscore the need ...

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Eight months into a healthy pregnancy, my belly suddenly hung lower. I noticed that the baby’s movements slowed, decreased in frequency, and seemed sluggish compared to just a few days before. Concerned that something might be wrong, I called my obstetrician’s office and described what I’d noticed. The nurse I spoke with gave rote and reassuring advice: “Babies often get crowded near the end of pregnancy,” she said briskly. “Drink some ...

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As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many.  Value-based care, determined by statistical analysis, is going to replace fee for service. Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared ...

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It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three. Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner ...

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“Management is about coping with complexity. Leadership is about coping with change.” - John Kotter Even before the results of the recent presidential election were in, few necessities were as present in our daily lives as the need to cope with constant change. This is true across all facets of personal and professional experience in America, but perhaps nowhere more than in health care. Over the next generation, we need to cope ...

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I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group. It never ceases to amaze me, as I fire up my computer, log on to my systems and bring ...

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