His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual. I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse's station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance ...

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Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I'd understand. "Imagine being on call 24 hours a day, seven days a week," he said. "You're in charge of a single patient, but she is needy as hell." Medical training prepared me for motherhood in some ways (the assortment of facts blurrily retained from my pediatrics rotation in medical school; the skill, or 
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In the New Yorker blog entry, Lisa Rosenbaum wrote about a topic dear to my heart: shared decision making (SDM). It refers to doctors empowering patients to make medical decisions based on their values and preferences when there is more than one reasonable path. Many researchers have found that shared decision making (with the help of decision aids) leads to more informed decisions and may even lower health care costs. As Lisa points out, ...

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It wasn't so much the side effects -- nausea and belly pain that had once kept me from enjoying my aunt’s home cooking. I didn't fill my prescription for the malaria prophylactic Malarone before a family trip to India because the $50 co-pay seemed outlandishly expensive to a medical-student-in-debt. Years later, I find that my patients skip crucial medications to treat diabetes and depression because of the reality or even ...

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Whether it lasted hours or months, every hospital stay is chronicled in that one final document: the proverbial baton passed from a patient's hospital doctor to his primary care provider better known as a discharge summary. This report has always been available to patients after they fill out a decent amount of paperwork. In mid-July, Massachusetts General Hospital began sharing discharge summaries with all patients through an online portal. The move ...

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Walgreens, the country’s largest drugstore chain, announced that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The nurse practitioners (NPs) and physician assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose ...

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Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story - passed down from resident to resident - goes something like this: An airline attendant called for a veterinarian's help. When no one answered, they settled for a doctor and an anesthesiology resident stepped up. He learned that a passenger traveling with her ...

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How much to treat this pneumonia? The Centers for Medicare and Medicaid took a step towards answering such questions by publicly releasing how much each of 3000+ U.S. hospitals charged Medicare for 100 common medical issues in 2011 and how much Medicare actually paid them. The charges were remarkably variable, even among hospitals that share a zip code. Massachusetts hospitals tended to charge below the national average (eg. ...

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The cabdriver pulled up to take me to the community hospital where I work several weeks each year. Settling into the back seat, I made my request before he reached the intersection: "Could you please take 93 South?" He was quick to ask me why, and I hesitated. I had taken this route dozens of times and had usually found it to be faster than the alternative, I said, but ...

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Would an ad influence your decision to go to the ER? You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the emergency department (ED)? What if that headache comes with a cough and shaking chills? Would an ad influence your decision? I came across this image ...

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