My most important patient requires my constant diligence. For this reason, I am seldom far away from him. Only a few minutes inattention and there will be problems. I cannot forget my patient; I am trained to attend to him constantly. I am a professional, and my patient is, ultimately, my customer and the customer’s service is paramount, I am told. I am reminded by policies and procedures as well, ...

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When he turned 45, Mitch Alsup bought a red Corvette. Mitch is a quick-talking guy with dirty blonde hair and a short, trim physique. He has a ready smile and is willing to share his story. “As a kid, I use to go down to the Chevrolet dealership and sit in a Corvette,” he recalls. “I wanted one when I turned 18, but I came from a poor family. I had to ...

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Guilt was not a huge part of my vocabulary until I became a mom.  I never felt much guilt about how I spent my time.  Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out.  And so on and so forth. And then I became a mom.  You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could ...

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In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis of the research addresses the safety of patients: that mortality under ...

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Dr. Brian Goldman, in his blog for CBC radio, wrote about the new article in the Canadian Medical Association Journal (CMAJ) on the sex ratio after induced abortion in Ontario, (i.e., sex selective abortion). The article in the CMAJ confirms what is no surprise to me as an OB/GYN, that the ratio of male to female births for a third child born to women who emigrated to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D. On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure ...

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I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200,000 a year when the median household income is in the mid-$40,000 range. What this article is ...

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Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2 a.m. at an emergency room to find a "closed" sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that ...

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I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs. I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in ...

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When was the last time you used heroin?  In the past have you injected heroin or any other drugs?  Are you currently using drugs besides opiates like methamphetamines, cocaine, benzodiazepines or alcohol? After two years of family medicine residency, I ask these questions like they are questions that everyone asks in a casual conversation with a patient.  Although these types of interviews are customary for me, I recognize that it takes ...

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asco-logo I was at a meeting in 2014, called the REV Forum; its objective was to rethink cancer care delivery by gathering patients, advocates, thought leaders, and entrepreneurs. Even now I am struck by some of the things I learned that day. One that stays in mind is when a woman who looked like she was in her ...

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For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors ...

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The practice of medicine has changed dramatically over the last couple of decades, with many of the changes unfortunately not so good for patients. It’s a well-known feeling among health care professionals, that among all the new elements of bureaucracy and information technology requirements and mandates, the one person who is often completely forgotten about is the patient. As someone who has worked up and down the east coast in ...

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ZDoggMD nails it again.  See what Doc Vader thinks about patient satisfaction.

Heart of summer. Early August. All of Holland is on holiday. We are sitting in the flesh-colored morning light, in his back room, stuffed away behind the nurses’ station. He is sick as hell and just 32. I am sitting next to his mother and his girlfriend. The intern and nurse are standing behind me, breathing carefully. He sits with his back to us, at his table. Visibly fighting for air. ...

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I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around. When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify ...

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Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there? I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to ...

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Despite the opinions expressed in column, "Here’s why you can’t believe 'top hospitals' lists," Harlem Hospital richly deserved the 2015 Top Hospital distinction it earned from our nonprofit, The Leapfrog Group. Our Top Hospitals committee sets the bar high, selecting only hospitals that perform at or above the level we would want for ourselves and our families. We used data from the annual Leapfrog Hospital Survey, calculating which ...

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