On the porch. It's that time of year again, when we escape from the heat of New York City summers, and head to New Hampshire, to the Central Lakes District, where my wife's family has had a house perched out over the clear waters of Newfound Lake for over 120 years. It's a small wooden house, with barely enough room for all of us squeezed in, painted bright yellow and orange, with ...

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"So, I'm getting routine labs on her." Wait, what? Statements like these often make the hair on the back of my neck stand up. One of our residents was seeing a healthy young woman for her "annual physical," seen just a few days after a routine postpartum visit with her OB/GYN after the uneventful birth of her third child two months ago. The resident was coming for his afternoon continuity clinic from an ...

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Yesterday, we had a meeting about leakage. No, it was not about urinary or fecal incontinence, but it was about care that could have been provided within our institution that ended up, for a multitude of reasons, happening with providers beyond the walls of our institution. Representatives from our accountable care organization had requested a meeting to go over some issues they've been having with our practice, including low levels of usage ...

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A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked "white as a sheet", and a physician who was at the gym told him he must go to the emergency department. In ...

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Recently, getting dressed after working out in the gym, the guy in the next locker decided to complain to me about his recent surgery. Having lockers next to each other had led over time to "What do you do for a living?" After discovering that I was a physician he has occasionally asked some medical questions, and done what a lot of people do when they know you're a health care ...

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A few days ago, just after dawn, while I was out walking the dog, our home phone rang and my wife answered it. She's used to my pager, cell phone, and home phone ringing at all hours, and so she was not all that surprised when an unidentified voice said,"We're looking for the methadone dose for patient John Q. Smith." She told him I was out of the house at the moment, ...

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At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual? At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result ...

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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments. While we are a very busy practice, and this is not ...

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I recently took a three hour online course on something I learned to do when I was a medical student. And I thought it was something I had been doing fairly well for the past 20 years.

New regulations have come down requiring all practitioners to take a CME-certified course on safe and effective management of opiates for acute and chronic pain. This has clearly ...

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Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie. Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to ...

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