“Listen, when I was your age, I did the same thing …” The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery. He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling. “What ...

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"If my father dies, you're going down with him." The words pierced the air, and suddenly there was silence. I hadn't noticed Frank’s son at first. He'd been pacing in the back of the family group gathered in our ICU waiting room. Now, up close, I could appreciate how large and intimidating he was. And I'd just had the thankless job of telling him, along with the rest of his family, a ...

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I have written before about predictions of the actual costs of Obamacare and the probable death spiral of increasing costs and decreasing participants. Several recent reports have brought more clarity to the cost realities. Recently regulators across the country approved rate hike requests by Obamacare insurance companies even greater than they originally asked for. For example, Pennsylvania regulators approved rate hikes of 33 percent, which was ...

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asco-logo Milly* was 82 years old and had been diagnosed with a recurrent ovarian stromal tumor — one that is typically seen in much younger women. Surgery was ruled out, and a colleague from outside of Boston sent Milly to me for an opinion about medical treatment. I reviewed her case before I met her: no significant medical problems, ...

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asco-logo My background in nursing has given me a perspective that many physicians don’t have. From the beginning of my career, I have valued the information that patients have provided me about the context of their lives, family, work, and beliefs. I have never cared for a knee or a prostate, but rather I have cared for a person whose life experiences ...

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Burnout is a popular topic of discussion among health care professionals, but preventing it often eludes us.  While burnout is common in many professions, it is particularly present in health care.  It is estimated that about half of all physicians in the United States suffer from burnout with numbers rising rapidly.  Burnout is associated with detachment from those around us and feelings of isolation.  Burnout can lead physicians to lose ...

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In her home country, everything is free. However, there is a catch -- certain services are only available to those who pay for private insurance. Those who are on the “free plan” sometimes must wait months for procedures. My patient said she knew many people who died on the list waiting for procedures. So, which is better: Free rationed care where people may suffer consequences waiting in line or overpriced care ...

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Otis was our first baby. He was covered in a caramel-colored fur, weighed 150 pounds and was the best bullmastiff dog anyone could ask for. He protected me from my husband’s incessant tickle attacks and thought that my lap was the best place for him to try and sit. Two years ago, I was walking Otis and he suddenly collapsed. After an extensive workup, including an EKG, blood work and an ...

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There are so many insightful stories out there about what happens when physicians experience life as a patient or family member. They always make sobering reading for everyone in health care. Over the years I’ve heard dozens of these stories from fellow physicians, describing experiences when they’ve unfortunately been sick themselves. It’s an inevitable fact of life for everyone that they will be the patient one day, but it’s often ...

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Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose? For humans, denial of death and marginalizing its effect on our lives is a major ...

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Every patient has a story and an experience, and my patient experience began on July 6, 2004. One month after graduating from high school, I was involved in a near-fatal car accident. My heart shifted across my chest, lungs collapsed, major organs were either lacerated or failed completely, my pelvis was shattered, and I lost 60 percent of my blood. I was airlifted to shock trauma near death and underwent immediate ...

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We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room. “I think you know what I am about to say.” His mother took in a deep sigh, her eyes already swollen from inconsolable tears. “I think he is dead.” The whole room sank. We were all punched in the gut by those words. “Oh my ...

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This is a story of a very special patient. A story that may change your outlook on life. When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening to her favorite band on her iPhone and humming along. Her carefree countenance was perfectly paired with the jovial tunes. I had admitted her to the hospital for an infected bedsore. She ...

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Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions -- maybe ask a few questions -- and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely. One of the most common of these medications is a statin. Imagine you exercise four ...

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In a recent TED Talk, businesswoman Margaret Heffernan explored a very interesting and relevant topic. She touched on the subject of productivity by referring to an experiment by William Mure, an evolutionary biologist. In this experiment, Mure set out to prove whether a flock of chickens could be more productive by filling it with what he termed “super chickens.” Basically, these super chickens were the top egg producers out of the ...

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I am currently a fourth-year medical student, and I will not accept mediocrity in my life any longer (and neither should you). When you were growing up did you ever wish for happiness? Did you ask for a good life? Did you want to feel fulfilled and self-actualized? Yeah me too. We are meant to reach for the stars, we are meant to go for our dreams, and we are meant ...

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“Doc, I’m tired.” This is a refrain that we hear from many of our patients who have been incarcerated in California’s prisons for decades. Now past the midway points of their lives, our patients describe how the absence of autonomy -- what they eat, how they dress, how frequently they bathe, how they spend their day, and when they communicate with their families -- has taken its toll, making them weary ...

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Not far from the busy pedestrian streets in the center of Vienna, down a quiet narrow street, lies a small cobblestoned city square. Before World War II, this city neighborhood was the bustling, vibrant heart of Vienna's Jewish Quarter, but today it is has a quiet, almost subdued feeling. Vienna's current Jewish population is only a small fraction of what it was before the war, and the quiet feel of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for difficult-to-treat migraine. She has had severe headaches, usually on the first day of menses, since menarche. The pain is hemicranial, pulsatile, and associated with severe nausea and vomiting but no aura. She frequently awakens with the attack already in progress. Ibuprofen was helpful in controlling ...

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We were a team of women. A strong, intelligent female attending, a fellow, me as the resident, and the eager intern. Gunners in the ICU. Throwing in lines and throwing out numbers and grilling newly published papers for truth. Then I got a call from the head of the department. I was asked about another fellow in the program. A male fellow. His behavior was in question. I was asked if ...

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