A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized. My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible and ...

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As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues. As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers ...

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“Son, just let me die.” Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited -- the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and ...

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The consult was for “decreased vision and eye pain.” Inpatient consults at the VA hospital come up infrequently, but when they do, it’s inevitably something interesting. As soon as I access the patient’s medical record, a flashing rectangular box encasing a smattering of phrases such as “warning,” “inappropriate behavior,” and “female employees” pops up on the screen. I’m accompanied by one of our female residents, Dr. Smith. Once we leave ...

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I was never a big prescriber of narcotics.  I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life.  Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin' you ain’t dead yet.” You fell down; it was going to hurt.  You learned not to fall.  Twisted your ankle doing something stupid (and it was always ...

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The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to ...

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Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels.  Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way. In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead ...

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"Beautiful girl, you can do hard things." I saw that quote on my favorite Facebook group recently, called Physician Moms Group (or PMG). This is a group of women who, like all of us, are just trying to “do” life every day. Because of our integrity and intellect, we are trying to do it better than anyone else. I think that’s from a Type A personality, combined with leadership and wanting ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications. On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate ...

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IMG_2940a KevinMD It was recently Match Day. At 12 noon EST, medical students all over the United States simultaneously opened envelopes which revealed the destination of their residency training. The tradition is an exhilarating and emotional event for everyone involved. For medical students, it is a milestone that symbolizes a dramatic life change and a new adventure. It marks the culmination of years of hard ...

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“Does anyone have thoughts about Mr. Jones?” I ask around the table. My primary care team sees veterans who were recently homeless. Many have been severely injured, and half have chronic pain. We have wise nurses, a committed social worker, and something else: time to focus on a vulnerable group. And here we are today we have Mr. Jones. A bit about his case. He has a history of shoulder pain dating ...

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Over 2 million Americans abuse or are dependent on prescription pain medications. These patients are in the office of every physician in the country, but only 3 percent of primary care providers offer them treatment. Many patients are being given a sympathetic apology, a hotline to call, or a dead-end referral.  Some of them are being sent to methadone clinics, which are often impractical, already-full, or deeply stigmatized.  Others make their ...

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Zubin Damania, also known as ZDoggMD, has a message to parents who are skeptical about vaccines.  Even if you don't agree, it's a video you should watch.

One year ago (read: before intern year), pretty much the most exciting part of my fourth-year emergency medicine rotation was having my pager go off. BZZZZ! I leapt into action, excitingly reading the text page: “Leg lac in E9.” I was on it. Suture kit in hand, I burst through E9’s thin emergency department curtains with abandon; I was going to fix this. The “leg lac” turned out to be a ...

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No, customer service in the U.S. is terrible when it comes to health care.  No, the customer service in the U.S. health care system is horrendous.  No, health care has the worst customer service of any industry in the U.S. There.  That seems about right. What makes me utter such a bold statement?  Experience.  I regularly hear the following from people when they come to my practice:

When I first seriously began discussing the possibility of applying to medical school with my family and close friends, I received mixed reactions. Although medicine seemed like a great fit for me in many ways, I also heard sad stories about relationships and even entire families that had struggled to survive the strenuous period of medical training (particularly residency). As somebody who values family and close relationships highly, I was ...

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Advice to doctors: Beware of what you say during a procedure! Before, we had a patient secretly record an anesthesiologist during a colonoscopy. Now, a patient hid a microphone in her hair, and secretly recorded the medical staff during hernia surgery. It's now national news.

Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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An excerpt from What It's Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician, Greenbranch Publishing, 2016. I passed the board exam in November 2011 to become a gastroenterologist. This is the last exam I have to take until I recertify in internal ...

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"I hereby authorize xxx, my patient, to donate plasma up to two times per week." I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma. By the time the fourth form came, I realized ...

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