President Barack Obama, whether wittingly or not, invested his entire political capital in reforming health care in America. He gambled and lost. Not because he had nefarious intentions, but because he left the gory details to a corrupt Congress and a shady cadre of lying and conniving technocrats, ending up with something vastly different from what he campaigned on. From everything I’m reading now, President-elect Donald Trump is about to ...

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As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers. Being someone ...

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During sports physical appointments, I routinely address preventive health topics that range from asking about alcohol, drugs, and sexuality, to addressing accident prevention and updating immunizations.  At one such appointment recently, a young male teen was due for two routine vaccines.  The mother accompanying him had no concerns about one of the vaccines, but expressed concern about the other. A friend had recently shared information on Facebook about how the ...

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The Affordable Care Act is perhaps the biggest overhaul of the U.S. health care system in many decades. Enacted by President Barack Obama in 2010, it made health care attainable and affordable to millions of Americans. Individuals with pre-existing medical conditions cannot be denied health care coverage; insurance companies have to cover essential health care needs including mental health and preventive services, children can be covered under their parents’ plans ...

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I remember that morning in January 2016 very well.  I opened up my Twitter feed to find many people linking to an article that made me stop dead in my tracks.  The New York Post was reporting that Dr. David Newman had been accused of sexually assaulting a patient in his emergency department.  He was accused of giving the patient a dose of propofol and then sexually assaulting ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man with type 1 diabetes mellitus presents to the office. He seeks advice on his diabetes management as he intensifies his exercise routine in preparation for participation in a 10-K race. He reports prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. His insulin regimen ...

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Dear patient, I may never get to meet you, which is a real shame. I think I would have enjoyed getting to know you and working together with you to overcome whatever particular medical issue with which you had come to meet me. We might have learned about each other. We might have learned about our community. We might even have made some kind of change together. I myself am a patient, ...

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"I did a weekend of 72 hours in which I only got four hours of sleep. I would also secretly hope to get in a car accident and maybe break a leg so that I would be force to take off from work ... just so I could get some rest. Thank God, I never got in an accident, but I have had colleagues fall asleep at the wheel." - Dr. ...

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Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire.  His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade.  However, I disagree with his latest initiative: to get hospitals who perform certain procedures at very low rates to stop performing them altogether. On the surface, it seems like a ...

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Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of ...

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We live in a world that is rapidly evolving and changing. The future is uncertain as policies change, as well as politicians. No one can predict what 2017 or future years will herald. We watch as dozens of news stories pour into our mobile apps every time we check in. And for those of us that practice medicine, health care research, and news coverage can change the way we approach ...

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Anti-immigration policies are hazardous to the health of immigrant patients. In the last ten years, there have been over 1,500 anti-immigration laws adopted by states across the country. These laws have come with discriminatory, racist, and xenophobic undertones, which has created a hostile environment for immigrants and citizens perceived as immigrants. Patients don’t need to be deported or detained to be harmed by these policies, laws, and language. Research shows an ...

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A huge thank you for your continuing readership in 2016.  I sincerely appreciate the vibrant KevinMD community, driven by your readership, contributions, and conversations. KevinMD is about to enter its 13th year as the leading platform for the voice of the health care professional.  I look forward to another great year. Here are the most popular posts of 2016: 1. An open letter to Justin Timberlake 2. The opioid epidemic: It’s time to place ...

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In January, the National Academy of Medicine is launching a new committee to address the high rates of depression and suicide among physicians and other health care workers in the United States.  They plan to bring together medical professionals, educators and hospital administrators, and I hope they will also bring to the table professionals who have experienced burnout, and who may have attempted suicide due to burnout.  I say this ...

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Recently, Dr. Michelle Herren, a professor of pediatric anesthesiology at the University of Colorado and Denver Health Hospital, resigned after posting racist comments on her Facebook page. In particular, she wrote that Michelle Obama speaks “ebonics” and stated that our first lady has a “monkey face.” Dr. Herren ended her post by affirming that she is not racist but was “just calling it like it is.” This post remained on ...

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Dear patients, One year ago, I wrote to you about my concerns for the future of my practice in light of upcoming changes to the Medicare system.  I explained my anxiety about the Medicare Access and CHIPS Reauthorization Act (MACRA), a change in fee structure from fee-for-service (I treat you in the office, submit the bill to Medicare, and they pay the bill), to “value-based” payment (I treat you ...

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Dear Husband, MD I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next "shift." I put quotations around "shift" because we both know you will not work 8 ...

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It’s 4:17 a.m. as I begin this entry. I’m scheduled to be at the hospital in 43 minutes for one of my last days on surgical rotation, and I’ve been working on the following text message since 3 a.m.: “Hi, team. Im afraid that im burned out and anxious. I will be taking today off. Sorry to be blunt but i felt it better than to make up an excuse. Thanks ...

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In a previous piece, I described the killer B's of burnout in medicine, namely, bleakness, boredom, and bureaucracy. Both times I went through burnout, the cycle started with boredom. I found medicine so full of the mundane most days, after about five years in practice, I grew restless. There's only so much time after your office is done, the kitchen is clean, and the kids are in bed to ...

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I listened to a Planet Money podcast recently titled, Burnout.  It dealt with the origin and characteristics of burnout, and I would highly recommend it. You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other health care providers and countless others. Looking back ...

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