I never knew Jess Jacobs, and she never knew me.  Everything I know about her I have learned from her Twitter feed, her website, and articles written about her.  She was the same age as me when she died recently.  She was educated.  She knew the health care system inside and out, as an expert in insurance and policy and as a patient.  But she was ...

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Like all children, I looked forward to July and August. It was a magical time I daydreamed about through the winter months. Summer was a time of endless possibilities. No school, no deadlines, no stress.  The dreaded alarm clock was banished to the night table drawer. With no homework due, no papers to be written, and no tests looming, all that lay ahead was fun and relaxation. The hardest decision each ...

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The surgeon is doing a tonsillectomy on a 4-year-old boy. Dr. Jones drops an instrument on the floor of the OR. The instrument is now contaminated and has to be sterilized by a special machine called an autoclave. This was a small hospital, so they did not have a large inventory of duplicate surgical instruments. So the circulating nurse put the instrument into the autoclave. As this machine locked in ...

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In an article from the Pew Charitable Trusts, an upcoming scarcity of OB/GYNs in the U.S. is predicted with a potential shortage of 22,000 OB/GYNs by the year 2050. Reasons given for the shortage are a growing population, female OB/GYNs retiring early and working part-time, residents entering sub-specialties and changing physician attitudes about work-life balance. Suggestions in the article to combat the shortage are increasing OB/GYN residency spots and supporting ...

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Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: "We’ve killed the way physicians should be." It is interpreted that 27K readers or more identified with what Dr. Jones wrote. In his essay, he claimed the identity of a physician was being "killed" by the reality of practice demands. The essay referenced an image of the ...

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Alvion Barr had a four-month delay in his diagnosis. He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both other doctors were on vacation. I saw him late Thursday afternoon for a rash, but he also asked what he could do about his heartburn. “Tell me more about your heartburn,” I said. What followed ...

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asco-logo I am sensitive to language and the way we use it in health care; as the editor of the Oncology Nursing Society’s premier research journal, the Oncology Nursing Forum, and as a sexuality counselor, words are my business and the tools I use to educate, inform, and disseminate knowledge. The conversation typically goes like this: Me: “Hello, can I speak with Mr./Ms. X ...

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Dear Pamela, Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army veteran. I’ve worked as an EMT, completed a bachelor's degree and two years of medical school, plus I’m raising a family. I’ve achieved amazing things, but I have never been defeated like I’ve been over these past few years. Honestly, I was less stressed in Afghanistan. Medical school is ...

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The world can be a lonely place. Despite technology designed to bring us closer, it seems we've become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face. Raw, unattractive emotions: grief, insecurity, jealousy. We mask those from others and even hide them from our deepest selves. Ultimately, rather than becoming more connected, I suspect we are cast ...

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Dear health insurance company, Let me set the scene for you.  It was a sunny August afternoon.  A young college woman with stars in her eyes and dreams of being a dentist came to my office.  She drove an hour to see me and would leave the next day for college. She was reasonably requesting that her implantable birth control be changed out so as to avoid pregnancy during her educational career.   ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual ...

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In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical ...

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When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to see my 30s if the world continued its march toward nuclear Armageddon. My father refused to even have the discussion. I’ll get to why he refused in a minute, but first, a bit of ...

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The new school year is just around the corner (or maybe it’s already started where you live). Either way, here are a few quick tips to make sure you start the year off right: 1. Sleep is key: Poor or insufficient sleep can have significant effects on school performance. Many of us (myself included) let our children stay up later during the summer months. But as school starts back, it’s important ...

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"I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I'm disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, ...

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We all want this sometimes, don’t we?  We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away.  But how often does that really happen? As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it's MACRA ...

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A colleague of mine was recently questioning her capabilities having lost yet another patient who had arrived nearly lifeless after being shot.  She was despondent over the nation’s overall complacency about our gun violence epidemic giving her far too many opportunities to fail or succeed as a trauma surgeon. Truthfully, neither quick, decisive action nor expert surgical skill was enough to repair that much damage. Not in the hands of any trauma surgeon. As ...

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Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning ...

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screen-shot-2016-08-16-at-5-08-11-pm Donald Trump is talking about Hillary Clinton’s health as are two doctors who have never evaluated Clinton. This attention on Clinton has renewed some interest in the letter Donald Trump released last year from his personal physician. Many outlets have picked it apart, but I want to tell you as a doctor exactly how bad it is. I would never write ...

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During my first rotation of intern year, we took care of a woman who walked into the hospital with a kidney stone and never walked out. 52 years old, diabetic but otherwise healthy, she had been vacationing in Vermont with her son and extended family when she became sick with high fevers. When her symptoms didn’t improve, her son rushed her to our emergency room where an imaging scan revealed ...

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