A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed ...

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I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, ...

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Of life’s two certainties, death, and cataracts, it seems statins defer one and prompt the other, although not necessarily in the same person. If you blindly love life, you may be blinded by your love for life. In the HOPE-3 trial, ethnically diverse people without cardiovascular disease were randomized to 10 mg of rosuvastatin daily and placebo. The treatment group had fewer primary events: death from myocardial infarction (MI), non-fatal ...

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Whether big questions or small, medically related or otherwise, social media users love to take their ponderings and perplexities to their friends to gather advice. Certainly, social media is a great place to poll opinions about the latest movie or book. Sure, some might find asking friends for medical advice online easier than going to the doctor. Some might even feel that this collective problem solving protects them if they believe ...

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Today’s restless society has taken its toll on modern medicine. Among all the strategies for protocol optimization and health insurance improvements, doctors get to spend less and less time actually talking to their patients. Each check-up needs to be performed in a certain amount of time, and every procedure needs to be completed as quickly as possible so that hospitals are efficient and profitable. While this makes perfect financial sense, it ...

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I am about to place my plate in the sink, until I see a single pea left on my plate. I recall a recent article in National Geographic that stated that one-third of all the food we produce is wasted. I have a Zen moment, and think of the journey the pea made to reach my plate. A farmer in California sowed the seeds six months earlier. A farm worker harvested ...

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If you are a doctor, everywhere you hear or read about all that is wrong in medicine.  Please do not get me wrong, the medical profession is under assault.  Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients.  For many of us in the profession, we feel helpless.  We feel ...

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Fidgeting in my seat, I waited nervously in one of the most crowded waiting rooms I had ever been in. Suddenly, I felt like a bucket of ice water had been dumped down my back; my legal name was being called over the dozens of waiting room sniffles. My instinct was to remain glued to my seat, not to let anyone know that I was the person attached to that ...

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I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy. Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill ...

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I dialed the number to return the call of the nursing home. The nurse who answered the phone was relieved to hear my voice on the other line: “Dr. Mass, thank God you called back! She has been pacing since she woke up, and she refuses to take her meds. We’ve kept her away from Catherine, so they don’t get into another fistfight. But we can’t handle her here anymore. ...

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We live in a headline/hyperlinked world.  A couple of years back, I learned through happenstance that my most popular blog posts all had catchy titles.  I’m pretty confident that people who read my blog do more than scan the titles, but there is so much information coming at us these days, it’s often difficult to get much beyond the headline.  Another phenomenon of information overload is that we naturally apply heuristics or ...

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A recent article suggested that the use of observation status for a hospitalized veteran was a dishonor to his years of service to our country because observation was going to subject him to higher out of pocket costs. This post created quite a lot of discussion and debate. While I agree with the author and commenters that observation is confusing to all and that there has to be ...

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The family medicine fellow set down her pen and inhaled deeply. “So when is it OK to cry with a patient?” she asked the senior attending across the table, a veteran internist in her mid-60s. About a dozen of us -- fellows, physicians, writers -- sat hunched over a paper- and laptop-strewn table in the fellows’ shared office, talking about a poem: Sharon Olds’ “Death of Marilyn Monroe.” In it, Olds ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is ...

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Like many boys born in the 60s, my heroes were often frontiersmen.  I grew up watching the Daniel Boone television series, with Fess Parker.  (I can hear the theme song in my head as I type.)  I watched the Disney production of Davy Crockett, and had a comic book of the same.  I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy ...

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Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to ...

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Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly ...

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"One of the most prominent definitions describes burnout 'as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'" - Maslach, Jackson & Leiter, 1996 In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout." In it, he wrote about the physical and emotional symptoms of ...

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I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means ...

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At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor. Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data. Leapfrog’s top 98 included 62 urban, 24 rural, and ...

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