My "aha" moment wouldn't come at the signing of my leave of absence contract. Nor would it awaken me at night with the chair-gripping dizziness I had come to expect. When the vertigo started in early December during my third block of clerkship, I chalked the symptoms up to stress. Over the December break, I met with my family doctor and casually recounted my symptoms. The vertigo had worsened, and seemed questionably ...

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Decisions about how many children to have (if any) or what type of contraception to use are complex. For patients who are not health care providers, the doctor-patient relationship remains a critical relationship by which these sometimes difficult decisions are navigated. As a practicing gynecologist for 13 years, I continue to be mystified at how many women report to me a nearly complete lack of counseling prior to being prescribed ...

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As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks' gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after ...

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It takes a big person to admit when you're wrong.  And on April 1st, ZDoggMD admitted he was wrong about vaccines in a big way.

What is happening in medicine?  How will these changes affect our patients? How will they affect how we deliver health care?  These seem to be the questions asked most often amongst physicians across the country.  I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future.  However, there ...

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In February 2015, the British Parliament approved the creation of a human embryo from the DNA of three people: mother, father and a donor mother. The modified in-vitro fertilization (IVF) technique, called mitochondrial replacement therapy (MRT), would help some mothers with known rare mitochondrial mutations avoid passing on unhealthy defects. These defects can cause severe or deadly diseases, which are often incurable, such as muscular dystrophy, heart and kidney disease, liver ...

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For a moment, let's forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not. I would rather, however, look at how Donald Trump in the White House might affect the day-to-day lives of physicians. And by this I am not referring to his support or opposition to universal health care, for I ...

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American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue. Status quo Currently, the status quo is such that health insurance companies and health care providers act ...

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As health care settings become more focused on patient experience and care for the whole person, issues of culture, diversity, personal beliefs, and values have come to the forefront. Staff are expected to deliver not only high-quality clinical care but to do so with compassion and care. Neither of these elements are new, but they are gaining attention as health care is increasingly measured on a number of quality indicators, ...

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Part of a series. Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike. First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction ...

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5 a.m. on a Friday morning, during a lull in my overnight shift, I got a text from my friend Julie (name changed). “Steve had a massive heart attack.” Me back: “OMG, what happened.” Julie: “Not sure, he called my mom, he thought he was going to die. Now they are doing a CT scan.” And so it went on. As I waded through the information, Julie thought she understood I realized that she ...

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Three (and a half) years ago, when I left my old practice, I was near burnout.  I was exhausted, not because of the amount of time I was spending -- it was actually about the same, if not less than I had worked before -- but because of an ever-increasing gulf between me and my patients.  I have always tried to give care that focused on the person with me ...

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Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year. What’s a poor patient to do? For starters: They can talk to their doctors about these costs. According to a study my colleagues and ...

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Science, to use the term correctly, isn’t a body of knowledge or a bunch of facts written up on a whiteboard by a crazy-haired professor. It’s a method, or way of figuring out things. Thinking and reading and learning from experts are all important, sure. But real science relies on experimentation. First, make an educated guess about how something works. Then design an experiment to test your guess. (I’m oversimplifying here. ...

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DearPamela-900x607 Hi Pamela, I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel ...

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The debate over the safety of giving birth at home, both for the mother and for the infant, has been debated for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1 percent in the U.S., although it’s much higher than that in many Western European countries. The shift to hospital births ...

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Currently, in American health care, experts are wringing their hands in confusion.  I mean, people have insurance, right?  And yet, health care is still expensive and dang it, people just keep going to the ER.  Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century. I’m not a ...

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A surgical resident writes:

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency. My questions for you: 1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency? 2. What should we do differently? I personally don’t feel that “more simulation activities,” which ...

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Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators -- to varying degrees. It almost seems like a rite of passage that the world of clinical medicine and administration are ...

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