As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world.  I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or ...

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I’ve noticed, as I get older life seems to travel full circle no matter your path or destination.  I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago. “Don’t do that, you’ll fall and hurt yourself, or try it this way, and the process will be much easier.” There is that brief moment of acknowledgment often followed by scraped knees or ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish "lumps" that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical history is significant for a ...

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Dear Macklemore, Recently, you -- the white-rapping, thrift-shopping, LGBT-activist-ing, Grammy-winning 2013 phenom -- teamed up with President Obama to deliver a message to the country about the current opioid epidemic. Now let me preface this by saying, I like you, Macklemore. I like the mixture of equal parts political, earnest and downright goofy that you bring to your music. I like that you seem genuinely self-reflective and ...

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"I love you," she said as I was leaving the room. Although I was stunned for a second or two, I wasn't really surprised.  She and I had gotten along famously from the beginning of our 15 minutes together.  She didn't "love me" in the way a patient with borderline personality disorder "loves" her enabling prescriber.  She loved me because I was there, I was experienced, I was kind, and I ...

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I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help.  I have deep respect for the challenge of medicine and the committed practitioners. When I left graduate school in 1988, it was the beginning of the movement from fee ...

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In the dark lecture room, I watched the neurologist's shadow flicker across the only source of light -- a projection of the New York City subway map. He pointed at Times Square station. If the subway system were a brainstem, then Times Square would be the pons, transporting vital signals like breathing, speaking, and swallowing. He likened the station's abrupt destruction to a stroke producing locked-in syndrome. Writer Jean-Dominique Bauby describes ...

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If that headline sounds like it can't possibly be true, that's because it isn't.  But British comedian John Oliver did recently give Americans a great lesson in bad "science," during a segment of his show, Last Week Tonight. Oliver often uses humor to take on serious social issues.  And what could be more serious than the news that smelling farts might prevent cancer? Lots of things, actually, as it turns out that ...

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Vox's Sarah Kliff wrote a story of how patients are the health care system's free labor.  It's a good article, go read it. I did a quick take on Facebook Live, imploring doctors and patients that they need to be on the same side.  We want to same thing: Better care for patients.  Neither can change health care by themselves.  If we truly want to make a difference, doctors and ...

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As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis.  His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and hepatic encephalopathy. It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service ...

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Physicians are accustomed to seeing patients at the end of their lives.  It is difficult to let families know they may lose their loved one.  Clinicians are often accepting of patients DNR orders before family members are ready.  This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention.  It taught me an unforgettable lesson. During the first ICU ...

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What is your dream job? It’s the one you would do every day even if no one paid you. When you find it, you never really go to work each day, you go and play. If that is the kind of joy received from working, then burnout will likely be a long way out of reach. Are there any jobs like that out there for doctors? Yes, there are. But ...

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A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I'm a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab ...

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asco-logo A recent AMA Wire article highlighted the resident depression endemic and identified some strategies for improvement. The upshot: Too many trainees are unhappy with their jobs. The most important tool used to gauge trainees’ satisfaction with their training programs is the ACGME survey. Since the ACGME is the organization that formally accredits training programs, ...

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Like many physicians, I’m a people pleaser.  On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering -- and I really meant it.  What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically. Medical school and residency didn’t adequately prepare me for the emotional strain of ...

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Twenty years of experience and research reveal two indispensable truths about hospitals and health care organizations that can no longer be ignored: Those institutions neglecting the basic fundamentals of patient care risk jeopardizing the quality and safety of care they provide. Nothing can have a greater short and long-term impact on the cost of delivering health care services than nurses. The central role of the nurse in patient care For more than 60 years, ...

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My first confession is that I don’t really care to what extent a female emergency physician decides to embrace her femininity on the job. And yet, a new generation of female physicians is reshaping perceptions of our profession: what it takes to succeed, and therefore what sorts of skills, temperaments, and character types belong in our field. There is the nascent #ILookLikeaSurgeon campaign that started on Twitter and grew to its ...

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For the last couple of days, the Twitter medical community has been discussing the latest in a long line of papers attempting to estimate the role of medical error as a cause of death. A recent entry appeared in the BMJ and was by a surgeon at Johns Hopkins, Dr. Martin Makary, who claims that 251,454 patients die from medical error every year. Makary's review extrapolated that figure from three papers ...

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Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010. More recently, a study published in the journal Preventive Medicine found that married men are ...

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I received the sign-out from a colleague that he was to be transferred out of the medical intensive care unit to our service, as we were the team on call that evening.  My intern and I prepared to see him in the unit before he was moved to our floor, which involved reviewing his chart and having preliminary discussions about continuing his care. Soon after, we arrived to the unit, checked ...

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