I was asked by one of my readers recently to write a post on how I maintain work-life balance during the all-consuming intern year of medical training. I love this idea because keeping myself sane while spending 80 percent of my time in the hospital has proven to be a constantly challenging task, and I’ve come up with a few ways to cope. Instead of giving tips that sound good ...

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"Safety first" is a mantra of today's hovering parents.  It's the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed. "Mommy, can I please have a water pistol?" "I'm sorry, honey.  You know how Daddy and I feel about guns.  This is a safety issue.  Now go and practice your violin and afterwards help yourself to some kale chips." The safety concept has crept ...

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I remember being more confident that most of my peers.  The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me.  Maybe it was on account of my lifelong pursuit of medicine.  I felt nothing but elation at the newly branded "M" and "D" that came after my name on the hospital badge.  I was no longer a volunteer, no longer a ...

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shutterstock_76711840 A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school." “Hmm … that’s strange … why would her physician be in the room with her?” I ...

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shutterstock_133319240 As a third-year medical student, I realized one particular morning on rounds that I had let the demands of the job overtake the joys of why I went into medicine at all. I found myself running behind my team, barely even able to say goodbye to the last patient we had seen. The human interaction had become an afterthought in the ...

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medpagetodayFrom MedPage Today:

  1. Methotrexate Helps Save Large Joints in RA. Patients with rheumatoid arthritis (RA) who received concomitant methotrexate with their tumor necrosis factor (TNF) inhibitor were less likely to need a large joint replacement than if they were on anti-TNF treatment alone.
  2. More U.S. Teens Opt for Birth Control With IUDs, ...

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As the rugged beauty of the Pacific Coast unfolded in all of its splendor, I was in awe of the entirely different experience: the one created by our Uber driver, Calvin (name changed to protect anonymity). My friend and I, attending our annual cardiology meeting in sunny San Diego, carved out a few hours of rest and relaxation. We were heading to La Jolla, a scenic seaside community about 20 minutes ...

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“Doctor, I have trouble breathing when I walk up stairs, and I cannot lie flat in bed, so I have to sleep sitting in a chair. I feel much worse than before I got pregnant.” I recognized the diagnosis at that point, but I continued the appointment to confirm my suspicions and to revel in the art of medicine. I listened to the young woman’s lungs, full of crackles from fluid backup, ...

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I’m walking very slowly with my dad down the produce aisle at the local supermarket, past the colorful waxed apples, Mexican mangoes and Rainier cherries, and imagining my life's blood trickling onto the floor from an invisible wound. As I pass by the misting system spraying the bins of green, red, yellow and orange peppers, past the lady reaching for carrots, past the stock guy balancing the heirloom tomatoes into a ...

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Spring is here. The days are getting longer. The temperature is slowly getting warmer. Green stuff will start poking through the ground and popping out on trees. We’ll see more of our neighbors, since they won’t be trying to get from their cars into their houses (and vice versa) as quickly as possible before they freeze. Pollen allergies will start up again. And grass allergies. So many people suffer from the watery, itchy eyes, itchy, ...

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Waaaah-Hoo!! – Slim Pickins as Maj. ‘King’ Kong, riding the bomb in “Dr. Strangelove” I am converted. Like many doctors, I was very leary of social media, wary about using it, skeptical of its professional value. Especially Twitter, but really all of the platforms. No longer: I have embraced social media, and it has embraced me. I feel a little bit like Dr. Strangelove, only the subtitle is now “How I Learned To  Stop Worrying ...

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I’ve just finished sitting through a wonderfully aptly named lecture: Probability and Statistics, in which, among other things, we learned (again) that the utility of various clinical tests depends at least as much and generally more on the patient and condition involved than on the specific test itself. From stress tests to mammograms to PSAs, the relationships of true and false positive and negatives, positive and negative predictive values all ...

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There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every U.S. medical school because 93.9 percent of the 18,025 graduates of U.S. allopathic medical schools matched in a specialty. But for the 1,093 (6.1 percent) U.S. graduates who didn't match things were not ...

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shutterstock_180321404 I have always been one of Angelina Jolie’s biggest fans.  The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in Girl Interrupted with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tomb Raider movie was released in 2003.  In that film, Jolie, who performs her own stunts, is seen ...

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While working at small rural hospital I was once again faced with the emergency physician’s dilemma.  Admitting  a patient and being told to write holding orders.  In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system.  All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble ...

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“I want to hurt myself.”

That was the only thing written on an otherwise blank page. The other day, the mother of a bright second grader, showed me that alarming note.  Apparently the boy wrote it at his school. She went on to tearfully explain that her child has constantly been bullied ever since joining the institution. Sadly, it is not uncommon to encounter such stories when your profession is ...

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By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it.  Most physicians believe it is absurd to use it as a marker of quality care, but have accepted it anyway.  We will “play the game” in order ...

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The patient was hacking sputum into a tissue when the resident and I entered his room. “How long have you had that cough?” “Oh this? As long as I can remember.” “But it’s been worse lately?” “Yeah.” “Worse how?” “More stuff coming out each time. See?” He opens the tissue. “How much sputum is there?” “Sputum?” “The stuff you cough up.” “I don’t look that close.” “More than two spoonfuls?” “Oh yes. Definitely.” “And the color?” “White-ish.” “Ever see any streaks of blood?” “Never.” “And how long have ...

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medpagetodayFrom MedPage Today:

  1. Nicotine Replacement in Pregnancy: How Risky? The absolute risk of major congenital anomalies was similar among infants born to smokers and those born to women on nicotine replacement therapy (NRT), but respiratory problems were worse in the latter group.
  2. AS Activity Tied to Future Risk for Heart Disease. Early ...

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Sometimes, after crafting an important or complex plan of care with a patient, I say: “Let me type all this into the computer so that, in case I run into that big bull moose up on Vaillancourt Hill on my way home tonight, the next doctor who sees you will know what we were thinking today.” Patients sometimes squirm or laugh nervously at that, but then they usually indicate understanding and ...

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