A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury.  Thank you for your insightful article and feedback.  You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.”  You (the patient) and me (a physician) are now in the same boat, headed the same direction with the ...

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It sounded too good to be true when I first heard about Theranos, a company that promised to revolutionize medical testing by making it possible to perform dozens of tests on a single drop of blood, rather than the several tubes that would typically be required. And that wasn't all. Theranos CEO Elizabeth Holmes, a Stanford dropout and media magnet whose wardrobe seems to consist solely of all-black outfits, promised ...

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Dear parents, Congratulations on your daughter’s acceptance into medical school.  Like the first day of kindergarten, this launch is notable for parents as well as children. You may have some concerns about the stresses she will face. Having been there, I can tell you there will be many.  Not to worry, though. Times are changing.  You daughter is free to learn among the brightest of the bright while avoiding problems women before ...

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"We experienced an iatrogenic event that produced an untoward sequela, and while it is now quiescent, it may still recrudesce." No one likes to be given bad news, especially of disease.  But first, you have to understand what it means.  When it comes to communication of medical information, the way the message is delivered is often just as important as the information itself.  Indeed, good communication is the backbone of every patient-provider relationship. The ...

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When my friend Madeline turned seventy, she celebrated in a big way: She walked a half-marathon; she hosted a cabaret for family and friends at which she sang and told stories; she traveled to China. Now, six years later, this dynamic woman has become a virtual prisoner in her apartment. She has undergone back surgery, suffered a nearly fatal intestinal infection and, after a fall, had bolts and screws placed ...

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Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube? All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t. It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional mishap with ...

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Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance. Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring ...

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To the American Board of Pediatrics: I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is ...

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Ezekiel Emanuel, the University of Pennsylvania physician and ethicist, has written an opinion piece suggesting many changes in both pre-medical education and the medical school curriculum. He would do away with many of our hallowed medical school prerequisites such as calculus, physics, and organic chemistry, feeling that those subjects are simply used to "weed out" certain students. I confess I once believed that such subjects were worthwhile. However, Emanuel makes a ...

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One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as ...

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Three weeks ago, I changed jobs.  I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital.  Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting. I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I ...

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July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever. The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, ...

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The time has come. The time has come for patients to know how dangerous the state of health care has become and to finally do something about it. I’m ticked off. So ticked off that I’m writing this in between office patients, and I really try very hard to prevent my patients from waiting. Apparently insurance companies feel practicing medicine is as easy as checking off boxes, like hanging chads ...

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“I love you,” she said as she was leaving the room. “I, I um …” “Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room. “Oh, I thought …” The slamming of the exam room door clipped off whatever the end of that sentence might have been. I sat down and rolled my chair over to ...

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Prince died of an opioid overdose. A tragic and avoidable fate but, even more tragically, one that is becoming increasingly common in the United States. Some people who overdose live on the edge of society–homeless and with no access to good medical care. Prince, by contrast, had several mansions and a number of physicians actively involved in his care, physicians aware of his problem with opiates. ...

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A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling ...

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Much is made of the date July 1st in the medical profession.  Freshly graduated physicians begin their training career in medicine as interns.  Although technically physicians, these interns are new to the clinical practice of medicine and all that comes with that.  Much has been made of the experience of the new intern.  Samuel Shem's House of God is a renowned novel about medical training.  Countless television series, chronicle the ...

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The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice. Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any ...

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This spring, thousands of medical graduates will cross the stage and become doctors. Yet practicing medicine isn’t the only career for these young professionals; the path to becoming a doctor also provides ample skills for entering the innovation economy. Today’s medical students are perfectly poised to change the gridlock of the U.S. health care system -- and medical schools should empower them with the support and business exposure necessary to tackle ...

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