“Pregnancy termination” and “infanticide” are two different words, used by two very different kinds of people, to describe the one exact same thing: abortion. The source of an argument is found by looking at the words used to frame it; the rest is filler. I am a medical school student. Like many of you reading this, my life is spent between the walls of the library and the walls of the ...

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Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, ...

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With the election of Trump and a Republican Congress, it looks like the ACA is doomed. Will it be repealed in whole or in part? Will something replace it? None of us, including the new administration, know exactly what will happen. But if it does get repealed, what exactly are the consequences? The ACA was never a full health care overhaul. It was a form of insurance reform that used subsidies ...

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To my dear patients, This has been a difficult time to be an American. I will never forget my walk through Central Park on the morning after the election; I have never felt New York so flat and somber. This election has brought out the worst in many. I have seen its ramifications in people’s health and fear that it may continue to have an impact. I want to express my ...

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Thanksgiving is this week, and I have a lot to be thankful for, both inside and out of medicine. Life isn't always easy as a resident, and to quote the lyrics of Journey, "And lovin' a [medicine] man, ain't always what it's supposed to be." What's a life in medicine mean to me? It's certainly not the glamorous. I'm on the back half of 30 years old. I've been a doctor for little over ...

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A few weeks ago, my employer sent me to a three-day out of town conference. I had mixed emotions. It would put a burden on me to work more than usual both before and after it, but I couldn’t help but look forward to the blissful, uninterrupted sleep I would get in a cozy, quiet hotel room. There was guilt when I realized that my wife would shoulder the full ...

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Dear doctors, Are you looking through our charts and wondering what you’ve gotten yourself into? Are you maybe wishing we were someone else’s problem? Yeah, we know. It’s OK. We know we aren’t the type of patient most doctors like to take on. There are a lot of strings attached to us, and there’s a lot of paperwork waiting to join that already insurmountable mountain of paperwork on your desk. We can’t ...

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I was at work a few nights ago. We had had a patient death early in the morning before I got there, and the body was still in the room awaiting the JP’s arrival. The family was en route back with the children (he was only 57) and the body was not presentable. Blood, saliva, a gaping mouth and lividity with rigor were a bad combination for the kids to see. ...

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Beyonce wasn’t kidding when she wrote the song “Girls Run the World.”  We as women wear as many hats as some of us have shoes.  However, the cost of that can be grave if we never learn to create balance in our lives.  When I say balance I don’t mean the balancing act, I mean the act of giving back to ourselves.   Imagine that you have an energy bank account.  ...

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"You have no husband?"  asked an oncologist at an Ivy League cancer center, his voice full of concern. "No," I replied. "No sons?" "No." "No daughters?" "No." "No sisters or brothers?" "No." "Your parents -- are they living?" "No." When I mentioned friends and extended family, he talked right over me.  Without a nuclear family, he seemed to think, I had no one. I'd been diagnosed with stage four gallbladder cancer, usually fatal within months.  The surgeon who'd removed three-quarters of ...

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In the middle of a five-way thoroughfare intersection, with the early-morning sun's glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap, whose silver eye stared helplessly from among the automotive debris of previous accidents. A policeman blocked the lanes until I could pilot my car into the gas station on the other ...

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Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!” Well, maybe I should've been more circumspect. I hadn't realized until then that people can understand “psychosomatic” in a different way than I do. I'd meant what ...

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The Accreditation Council for Graduate Medical Education (ACGME) released a proposal last month that will affect physicians in their first year of training after medical school. Currently, there are regulations to prevent these doctors from working more than 16 hours at a time. The new proposal wants to remove these limits, extending the maximum shift to 28 consecutive hours. There is an outpouring of public discourse on the issue with ...

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It is 6:08 p.m. on a Monday night, and I am sitting in an unlocked patient exam room, my uneaten lunch opened in front of me, clicking through a patient’s chart, all to the constant whir of my breast pump. I last breastfed my infant at 6 a.m. this morning, and the discomfort in my chest has only amplified as the 12th hour has gone by without time to express ...

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  It’s Wednesday, the day after the election. I spent the previous night clicking from one website to another, trying to find someone who was refuting what the others said was true. And when it became inevitable, I held my infant twin boys and cried. Now I’m in front of my exam room, walking in to see Mr. Bundy. I open the door to find him wearing a red hat embroidered with ...

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In my previous post, "Have physicians finally joined the working class," I discussed the changes in the health care system regarding physicians roles in these systems. In this post, I propose two strategies that could help physicians regain some influence over their work and to participate fully not just in the execution of strategy from management but also have an input in creating it. Building unions There has been a ...

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I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year. This strategy was implemented ...

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During the Q&A period after a presentation I gave recently on understanding and preventing physician burnout, a physician in the audience voiced her vehement objections to the current electronic health record (EHR) with a simple statement: “We need a revolution.” In a few words, she described her frustrations with the EHR. “It is meaningless -- full of fields that we cut and paste from other fields. There are an ever-growing number ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing ...

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She is tall, thin and wears torn jeans like a mannequin. A silky top flows around her, masking the thin torso, the exposed ribs. Her hair is long, fine and the ends are perfect. Her face is smooth, drawn, a bit careworn, but that is why she is here. She carries herself with an aristocratic bearing that is not learned but genetically endowed over generations. She is rich, entitled and ...

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