A.J. Smith, a pseudonym of course, walked into my office today, unhappily.  Most of her topical medications for acne caused too much irritation.  The ones that didn’t, weren’t working.  The doxycycline caused photosensitivity in the past.  But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared.  As such, that’s what my patient demanded.  There was only one problem.  The degree of her acne didn’t warrant ...

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A few months ago, I was on my general surgery rotation on the colorectal service as a medical student. It was in the late afternoon that we started a case of a robotic rectopexy to repair a rectal prolapse. Our patient was a kind and warm 89-year-old woman. The operation finished without a hitch. As we undocked the da Vinci machine, the resident and I began to suture closed the multiple ...

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I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made ...

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Three weeks ago, I changed jobs.  I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital.  Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting. I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I ...

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Having recently watched a cable television recreation of the Clarence Thomas confirmation hearings, I am left thinking about how far some of us have come and how far some of us haven't. The confirmation hearings of Supreme Court Justice nominee Clarence Thomas in 1991 changed the concept of sexual harassment in the workplace by bringing the issue to the forefront. By the time, I started residency nearly 20 years after the ...

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I am forced to attend one of these mandatory continuing medical education (CME) events. My malpractice insurance provider has a deal with the state medical association. To get lower rates, I have to be a member of the association and every 2 or 3 years attend a risk management training session. I make it on time, despite the traffic. As I walk into the lobby of this rather nice building, looking for ...

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Maybe it’s just me, and maybe this is a regional/local phenomenon, but I have noticed a sharp increase in the number of non-physicians who sport their white coats on a daily basis around the hospital. First, let me preface this piece by saying I have absolutely nothing against any person who partakes in the care of patients; in fact, I commend all the helping hands that routinely dedicate themselves to health ...

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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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As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues. As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers ...

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The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to ...

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