Health care providers are often uncomfortable discussing issues of religion with patients, despite studies that indicate nearly 9 in 10 Americans believe in some sort of spiritual power. As a medical student, I have noticed that religion plays an important role in many patients’ lives, and that conversations about spirituality can build rapport between doctors and patients. As the United States becomes increasingly diverse across religious lines, it is imperative for ...

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A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and ...

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John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain medication and presented to the ER for another “handout” of hydrocodone. He admitted that life was taking its toll, and he was beside himself from aging. Was it time to ...

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Benjamin, Jr. was the apple of their eye. He was cute and inquisitive, and smart. Very, very smart. The minute he took his first breath into this world, his mom and dad had already ordained him as a future MD. He would become a doctor and follow in his father's steps. No questions asked. He would become the second MD in the family. Every birthday, his parties were doctor-themed: kiddie ...

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A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles. But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction. The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their ...

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I find interesting how much lies in the fate of the day's mood when it comes to forming a new patient-physician relationship. I can have one of my typical days (and thankfully this is usually the case) in which my mood is great; I stroll into work, after having sipped an entire cup of coffee, maybe nibbled on a Moroccan cookie or two, and donned my white coat and stethoscope, ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Our institution, like countless others across the country, has been working to institute processes to achieve the “triple aim” of improving the quality of health care, increasing patient satisfaction, and reducing the cost of providing that care. As chair of my anesthesiology department, ...

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This is my 12th year as a physician in the United States. I was born in London, grew up in Berkshire, and decided to become a doctor when I was a teenager. I remember being asked what I thought about the National Health Service (or NHS, the UK’s government-run health system) during my medical school interview. That question is almost a rite of passage for anyone applying to medical school in ...

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Recently, the American Medical Association CEO called digital health care products modern day "snake oil." As a provider and a technologist, I think we need a deeper dive to understand the issues, avoiding the kind of hyperbole that’s so common in politics today. Paul B. Batalden, MD, Senior Fellow, Institute for Healthcare Improvement (IHI), once said "Every system is perfectly designed to get the results it gets." Let’s take ...

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I was standing outside of the patient room with two family members, a faithful wife, and a devoted mother. In the sea of faces that surrounded his bed on a daily basis, these were the two that stood out to me. For this young man in his 30s who was battling metastatic colon cancer, his wife, and his mother were his strongest advocates, constantly seeking answers about his prognosis and ...

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(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.) Dr. Stephen Cluff is like Yoda. Judging by body hair, he's more like Chewbacca. But he's short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet's voice. If I'm stumped on a case, I'll ask him. If I'm pissed off about department politics, I'll call him for advice. If I want ...

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“You’re nothing but a punk ass kid.  And you’ll die a punk ass kid!” With that, she stormed out of the exam room, leaving me sitting on a stool, slamming the door behind her.  Apparently she walked straight up to the front desk and asked to file a complaint about me, but left prior to receiving the paperwork. Most all physicians will immediately know what the interaction involved.  I hadn’t been mean ...

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"It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended." – Joan Didion, Goodbye To All That So it feels at the end of residency. Of course, there is a graduation date. ...

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I was a few weeks into my surgery clerkship and was on the tail end of a student call shift. I had been at the hospital for almost 24 hours, and the last thing left to do before I embraced the comfort of my own bed was to round with the faculty surgeon on call that weekend. The night had been busy, but I was prepared to update my attending ...

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It’s likely that you or someone you know has attempted to purchase tickets, or at least talked about the difficulties of purchasing tickets to Broadway’s most popular show, Hamilton. While participating or overhearing the discussion, the conversation has likely pivoted to how expensive ticket prices are on the secondary market. It has become so difficult to get tickets through the box office, even with the partial block ticket releases that ...

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Many people, even those who work in the operating room every day, take safe anesthesia care for granted.  There has been growing pressure recently to abandon the team model and remove physician anesthesiologists’ supervision of nurse anesthetists with the latest threat coming from within Veterans Affairs (VA) health care.  For our veterans, our heroes and arguably some of the most medically complex patients, having both physician anesthesiologists ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. “Before we end the meeting, I would like to thank our staff, without whom none of this would have been possible …” I can’t count how many times I said that or something similar when I was the American College of Physicians’ (ACP) Rhode Island ...

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As she adjusts her sunglasses, Mary squints to protect her sensitive eyes from the sun.  Four years ago when lymphoma threatened her life, doctors gave her a 5 percent chance of survival. “I really should be dead right now,” she states casually. A bone marrow transplant gave this patient a new lease on life, allowing for the treasured opportunity to mother her 8-year-old son. The transplant has been successful, but her ...

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It has now been confirmed that Prince’s untimely death resulted from an overdose of the drug fentanyl. It is unclear whether the lethal dose of fentanyl was a prescription medication or a counterfeit “analog” drug from the illicit market. Regardless, the facts are now clear enough to know that the U.S. health care system failed Prince in the same ways it is failing the 78 Americans who die every day ...

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In 2008, mental health advocates hailed the Mental Health Parity and Addiction Equity Act as “historic;” putting an end to what Sen. Edward Kennedy called “the senseless discrimination in health insurance coverage that plagues persons living with mental illness.” The law requires most group health plans to offer coverage for mental health and substance use disorders equal to that provided for medical problems. Two years later, the Affordable Care Act extended ...

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