Recently, our three-year-old wandered into our bedroom around 4 a.m. waking me up, saying he was scared. As I did the previous few nights when he did this, I muttered a curse word to myself and picked him up to carry him back to his room. Upon lifting him, a wrinkle in the routine emerged — he was naked below the waist. At some point, before he entered our room, ...

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Patient-centered care (PCC) seems to be a popular buzzword among policymakers and administrators in recent years. Indeed, many physicians see our health care system as payer-centric, many patients see it as physician-centric, and no one seems to see it as patient-centric. While putting the patient at the center of what we do as physicians is critical to improving the triple aim of better care, better health, and lower costs, it ...

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I met “Samantha” during my first rotation as an intern. She was a strong-willed and optimistic lady who weighed about 100 pounds. She was dependent on a tube in her stomach for nutrition, and she appeared 10 or 15 years older than her age of 44 years. Pictures of her children were next to her bed. I asked her how we could help her. She cried. Her husband of 20 years ...

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The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland. In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private ...

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The Trump administration has made clear its intentions to drastically reduce the size and intrusive nature of government. Let’s hope that extends to the Medicare Access and CHIP Reauthorization Act, otherwise known as MACRA, the heavy-handed new government “value-based payment” program for medical care, enacted in 2015, and set to rear its ugly head beginning this year. MACRA must die. MACRA is administrative overkill in an industry already overburdened by ...

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Recently, I watched a disturbing video of a fellow physician being dragged out of an airplane. I find it hard to understand how these events unfolded despite Dr. Dao being a customer who chose to fly United, paid hundreds of dollars for his ticket and legally boarded his flight. Whether blame belongs with United or the Chicago Department of Aviation, this was an unsettling occurrence. Yet somehow — I wasn’t ...

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The media is quick to point out the important role of American Medical Association (AMA) and other professional bodies in shaping the future of health policy in the United States. While these organizations have a certain responsibility, it is becoming increasing clear that medical and public health students will shape the future of post-Obama health care landscape. Recognizing their role is pertinent. While physician members from AMA are the practitioners of ...

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Why does the universe have conscious beings? The physical and biological laws of nature do not seem to explain the existence of conscious creatures such as humans. Neuroscience has done well to explain many of our behaviors, illnesses and medical therapies based on purely physical and observable rules. But no one has ever measured consciousness. And yet it appears fundamental to whether my patient will recover from their disease. After 15 ...

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In medicine, there exists a dangerous condition that affects millions of Americans each year but is woefully underdiagnosed. It affects how long we live and how much we pay for health care. It impacts the way doctors treat us and care for us. Yet, many health care providers are reluctant to acknowledge that this condition exists. That condition is bias in medicine. We know that bias and discrimination kill. In politics, the ...

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Today, I am a 40-year old with type 2 diabetes. I have been on glyburide since I was diagnosed four years ago and am otherwise healthy, although my blood pressure today is 140/96. I don’t check my glucose levels at home because I don’t have a monitor. Typically, I avoid sweets, but my diet is high in natural sugars, carbohydrates and starches. The only exercise I get is walking around ...

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I have fond memories of my first class in the anatomy laboratory. It was the Monday of my first week at medical school. I’d spent the last night pouring over my newly purchased anatomy textbooks. I wondered how I would ever appreciate the countless anatomical details of the human body. But as I stood around the benches with a body donor, everything changed. Suddenly all the organs, vessels and tissues ...

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The setting: an inpatient unit in the Bronx, circa 2005. I was a resident (and hence was likely disheveled, groggy or exhibiting some other outward display of exhaustion) of the internal medicine program at Albert Einstein University Medical Center/Moses Division, aka Montefiore. The fact that the program was considered "malignant" by those in my industry — mainly due to the strict nature of the training program — likely strengthens the possibility ...

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At the end of my daughter’s first week of preschool, she came home with a burning question: “Mom, my friend at school says that she has two days in a row when she and her mommy and daddy are all home at the same time. They call it a weekend. Will we ever have a weekend?” I was floored. That simple question encapsulated the only life she had known as a ...

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An excerpt from Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. Near my office, there’s a breakfast-and-lunch joint where strangers sit down at shared tables. When Joseph, an attorney ...

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Making a diagnosis is one of my most common challenges. Families and patients are understandably more interested in the therapy to alleviate illness and suffering than exact diagnosis. We are swept along with this laudable therapeutic objective in the current of prompt empiric therapy bringing relief and hopefully confirming an empiric diagnosis and buying time before more definitive testing. I object to this approach even as I engage in it. Necessary ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, ...

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I have come to believe that humility is an essential component of wisdom. Never have I found this truer than in the practice of medicine. In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble. Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact, the label "difficult" assumes the problem ...

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Free speech is one of our bedrock constitutional rights. The battle over what constitutes lawful free speech is ongoing. But the issue is more complex than I can grasp with legal distinctions separating political speech, commercial speech and noncommercial speech. And, of course, the right of speech does not permit the free expression of obscenity or "fighting words" along with some other exclusions. There is no right to free speech in ...

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We are neurosurgeons, albeit not rocket scientists, but with our insider knowledge, it should be easy for us to understand “narrow networks.” Unfortunately, this is not the case so we can imagine how difficult it is for our patients. Consider the following scenario:

A 52-year-old woman is receiving long-term care for multiple myeloma primarily involving the spine. Well-coordinated neurosurgical and oncological care is provided through a large multispecialty group; however, if ...

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The patient, I surmised, was the one in the wheelchair with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter. I introduced myself. I had been right about the other woman being her daughter. It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a ...

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