asco-logo She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, ...

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When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year -- ...

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One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care. Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at ...

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Some maladies that attract psychiatric attention are unequivocally brain diseases.  Huntington’s disease.  Brain tumors.  Lead poisoning.  However, these are not psychiatric diseases.  Huntington’s is a genetic abnormality diagnosed and treated by neurologists.  Brain tumors are managed by neurosurgeons and oncologists.  Lead toxicity is treated by internal medicine.  Indeed, a long list of medical and surgical diseases include psychiatric features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile delirium to name a few.  One important ...

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Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right? First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right ...

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The customer is always right, or so the saying goes. If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl. It can sometimes ...

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I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent. Just because something isn’t suspicious doesn’t mean that it isn’t odd. Shkreli is a perfect poster child for rapacious ...

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When I was a new attending, an older man came to see me as a new patient.  He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest.  An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him ...

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A JAMA Surgery Viewpoint recently suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics. The paper acknowledged my criticisms of the Finnish study that found that simple appendicitis could be treated successfully with antibiotics in almost 75 percent of patients. I respect the authors of the JAMA Surgery article and am happy they ...

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The best defense is a good offense. This is certainly true when it comes to online reputation and digital presence. Doctors should be using social media and other online platforms strategically.  Health care institutions without a medical professional as a social media strategist are taking a huge gamble. Imagine a politically polarizing communication related to your organization that was not intended to be public, but was leaked and widely circulated on the internet. ...

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"Donald passed away." We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces.  The smiles were born out of a personal experience with him in ...

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burnout Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right. We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f'd up so fast? Attention medical students and doctors: It’s not your fault. Burnout is physical and mental collapse caused by overwork. So why ...

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Recently, during a typical day as a developmental pediatrician, I walked down the hall to schedule an ophthalmology appointment for a toddler. As I spoke with the secretary, I saw a thin “new patient” chart on her desk for another patient. I recognized the name at once and was immediately transported back 25 years ago, to when I was a fellow in training at the center and learned a very ...

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Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients? After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily ...

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There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss.   This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering. In his classic, often quoted, 1942 short story, Runaround, ...

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You may be forgiven after reading some of my articles for thinking that I’m somehow "anti-health care information technology." It’s a subject that I’ve written a lot about over the last couple of years, mainly because I feel passionately that our use of information technology at the frontlines of health care needs to drastically improve. But let me start first by making a confession: I love information technology. I am just ...

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Today so many physicians are not able to see pharmaceutical representatives (PRs).  However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for. I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take ...

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This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy.  People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity. Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is ...

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Recently, another study was published showing that SSRI antidepressant use during pregnancy is associated with increased rates of autism in the children.  By my count, this is now the tenth study on this topic -- all of which found links between SSRI antidepressant use in pregnancy and autism in the offspring.  Most of these studies were recently reviewed, and also concluded that SSRI antidepressant use during pregnancy is associated ...

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I have a dream job. I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday.  I’m off Friday through Monday, and I don’t take any call.  I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety. It wasn’t always this way.  Like all new doctors recently out ...

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