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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I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — ...

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  “Medicine Purple is now rounding at Room 202.” The announcement rang throughout the hallways on the lower pavilion. It was an announcement I had heard many times before, but this time it was quite different. As I glanced in the upper right-hand corner of the electronic medical record of my first patient, the following glared back at me in all capital letters: “ATTENDING: COOPER, JOSEPH DAVID.” I had imagined the ...

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I am a professor of family medicine at the University of Minnesota Medical School. During their third and fourth years, students must complete a four-week clerkship in family medicine. The clerkship includes a "significant-event reflection" project, in which students discuss patient encounters that they've found especially meaningful. Over nearly a decade as a facilitator for these groups, I have heard many powerful and emotional stories. I've often felt deeply moved--and admiring ...

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“I’m not really a pill person.” “I was never one for all those pills.” “I don’t really like taking those pills.” “I’m not really into taking pills.” As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!” Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields ...

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The patient looked angry and I felt his frustration. His voice was rising, “Why is the chart 54 pages long? My son has only been here five times!” In the olden, pre-electronic health record days, chances are the chart would most likely have been less than 10 pages. However, since the government takeover of medical records, this is no longer the case. When the government rolled out its meaningful use ...

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Over the past two days, listening to separate podcasts, I have heard the same story and now have a better understanding of artificial intelligence. A Freakonomics podcast — The Future (Probably) Isn’t as Scary as You Think:

And in general, what’s happened in the past couple of years is the best chess player on this planet is not an AI. And it’s not a human. It’s the team that ...

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I recently had the opportunity to join Boston news media veteran, Dan Rea, on his AM radio program, Nightside with Dan Rea. It was a one-hour call-in program and an eye-opening experience for me. Dan and I chatted about connected health and how it can truly disrupt care delivery and put the individual at the center of their own health. Then Dan opened the lines to the ...

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In the technology-thick landscape of modern health care, the physical exam remains in a backwoods. Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole, the exam has barely changed in the past century. Patients still open up and say "ah," take deep breaths and gaze at a tiny light peering into the back of their eyes. A well-done exam can still determine whether ...

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Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but ...

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A few months before election day, a grassroots group was created on Facebook called Pantsuit Nation. As the name probably implies, it was a group for Clinton supporters, where we shared our positivity about Hillary Clinton as a candidate and offered endless empowering stories about why we were voting for her. The group was secret, but as its numbers swelled to over 3,000,000, it was hard to keep ...

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