Doctors have become a profession of whiners.  Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away. It was not always so.  Medicine is a career where idealism runs rampant.  In medical school interviews, young students really do answer that they want to help their fellow man.  Nonetheless, in recent years ...

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Recently, a patient of mine died of cancer, whom I loved very much.  She had a special way of enjoying life; a half, wise smile that after our many years together did not take me too seriously and reflected her deep inner strength.  She taught me about joy; I will miss her always.  Her husband, understanding my loss, said that it was alright, that I had done my best, that he ...

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Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do. Why do doctors over order? These same people thought a ...

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Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it.   Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain. The 92-year-old patient is bleeding into her head, but has blood ...

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"If it walks like a duck and quacks like a duck, it is probably a duck. " At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an ...

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Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan. “Quality.” We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”, “deep-dive” and perhaps even “personalized medicine,” quality has begun to feel like water torture and risks being deprived of flavor or meaning.  However, do not so fooled or bludgeoned that you lose ...

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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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Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you. Cancer is a ...

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Romeo and Juliet, Act II, Scene II: "What’s in a name? That which we call a rose by any other name would smell as sweet. So Romeo would, were he not Romeo call’d, retain that dear perfection which he owes without that title." I saw a consult the other day, an older gentleman with a new cancer requiring complex evaluation and extended care. Scary, hard stuff, but with the possibility of ...

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It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor. For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis?   The chest ...

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