How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys. Yet in medicine, it's common for practices to schedule patient visits in 15-minute increments -- often for established patients with less complex needs. Physicians face pressure to mind ...

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There are over 400 pediatric intensive care units (PICUs) in the USA, as most recently estimated by the Society of Critical Care Medicine. These units vary widely in size, from 4 or 5 beds to fifty or more. The smaller units are generally found in community hospitals; the larger ones are usually in academic medical centers, often in designated children’s hospitals, of which there are 220. Given this size range, it ...

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For almost ten years now, family physicians have been the most recruited specialty in the medical profession, and that is not likely to change anytime soon. We face a huge shortage of primary care physicians that is only going to get worse because we aren’t training family doctors as fast as they are retiring. Business training isn’t in the curriculum What this means for me and my fellow family medicine residents is ...

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We stand outside in the heat. We swat at the occasional persistent mosquito. We try to ignore the sweat beading down our foreheads and the backs of our necks. We retreat to the deepest recesses of shade we can find. We wish for a hint of a wisp of a smidgen of a breeze. We hold court on life and love. We laugh and tease and are determined to have ...

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A woman in her mid-thirties with a terrible limp and a past surgical history in the dozens became my patient two years ago. Her prosthetic left leg served her well, but her right leg was moving awkwardly because of advanced hip arthritis and a formerly shattered ankle. She was on long-acting morphine and short acting oxycodone. Her Social Security disability insurance didn’t cover the long-acting form of oxycodone. She told me several ...

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As physicians, we are charged with extending empathy to our patients. In addition to a professional responsibility, empathy is also a mechanism for improving patient care and professional satisfaction. It has been associated with better patient satisfaction, clinical outcomes, fewer medical errors and lawsuits, as well as provider happiness. However, while physicians can be expected to pursue the ideal of empathy towards individual patients, that of empathizing with populations is ...

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I am a doctor daughter. I am exhausted. My emotions are bubbling close to the surface, and I fear that at any moment, someone will do or say something to me that will cause me to lose control, which I’m not allowed to do because I’m also a female physician in a leadership role, and our emotions must be held in check. I watched one of my mentors be memorialized last ...

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I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he's taking it in stride (he nonchalantly quipped, "seems I have lung cancer"), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years. But that doesn't mean he's always ...

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You ask your patient to follow instructions and when they see you at their subsequent visit, they have not made the changes you suggested. We have all been there, often placing the blame on their lack of interest in their health. Have you ever thought to dig a little deeper? The average American reads at a middle school level. There have been a series of studies trying to shed light and ...

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Almost every day over the last few years, someone has written about physician burnout or depression. The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself. peeing The paper equated faculty and residents supervising students ...

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I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following:  "Follow up with your primary care doctor."  Or, if they didn’t have one, "Follow up in one week with a primary care doctor."  I laughed to myself.  Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we ...

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The last couple of decades have seen a dramatic shift of power and clout away from individual physicians and towards administrators and the business side of health care. In many ways, physicians have nobody but themselves to blame collectively; because for any large and respected group of people to surrender so much autonomy so quickly, a lack of strong leadership must always be a factor. So many different reasons for this ...

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I recognized a glitch in my electronic medical record's decision support software when it prompted me to consider prostate and colorectal cancer screening in a 93-year-old man, who, though remarkably vigorous for his age, was unlikely to live for the additional 10 years needed to benefit from either test. Although deciding not to screen this patient was easy, determining when to stop cancer screening in older patients is often more ...

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Aggressive control of blood pressure has saved millions of lives and has prevented millions of people from experiencing heart attacks, strokes, and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but when primary care doctors like me help people get their blood pressure under control, we do just as much good as any of our colleagues who practice as cardiovascular surgeons. ...

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Thanks to all the nurses who take care of my patients and every other patient. I may be a doctor, but you are the ones who deliver the care. You give the medications and hang the IV fluids. You wash the patients and turn them. You check their vitals and listen for bowel sounds. You walk with them. You talk with them. You fulfill their needs. And you provide comfort to ...

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Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café. His maître d' and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his ...

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Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He's forwarded a letter of concern from a specialist from a different hospital. It's about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick ...

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In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?” “Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming. “You students are ...

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Every year around Match Day, medical and pre-med students alike worry about a rumored “residency cliff.” The theory is that the number of new medical school graduates will soon outstrip the existing inventory of residency positions, and the overflow applicants will be left in professional limbo. While that picture seems scary, it’s time for some good news. I’ve believed for years that this concern is more phantom than real, but now ...

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