I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example.  Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.”   He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the ...

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It occurs to me that I talk to my patients more about death and dying, than about sex.  It is not that I lack interest or an appreciation of the importance of intimacy, but like most physicians I fall into the trap of fighting the dread disease, instead of focusing on the wonders and power of wellness.  Still, we do not rise each morning planning for our demise, rather we ...

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When a patient leaves you for another physician, they simply cancel their appointments.  You might get a message that says they are moving on and, two months later, you get a follow up letter from the new doctor. However, Sam was unusual. He came in to tell me that because of my mistakes, his wife was transferring her care. What made our confrontation remarkable was that Sam was wrong. I had recommended that ...

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It is in our nature to lie.  Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication.  What happens ...

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New Jersey is considering following four other states in legalizing physician-assisted suicide. The Death with Dignity Act would allow people with less than six months to live to receive a prescription for a fatal cocktail and then to commit suicide at the time of their choosing in the privacy of home. Recently, I had the opportunity to participate in a debate on the merits of the proposed law.  While I oppose this ...

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After you finish medical school classes, the night before graduation, they take you to a dark, quiet room.  There, among leather bound tomes 300 years old, diseased skeleton trophies swinging behind glass, as you sip 50-year-old port in ancient crystal, they tell you the secrets. This is the wisdom passed not in lectures, rounds or at the operating table; it is the hallowed legacy of thousands of healers over the millennia; ...

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One of the first things I teach medical students is to be aware that they have arrived in a bizarre land.  The strange things they see, the disturbed experiences they have, the weird stories they hear, are like noting else in life.  I advise students to stay in touch with their feelings, to note what shocks, frightens, or embarrasses them.  Remember those emotions now, because as doctors learn their craft ...

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Recently I met the husband of a patient with a diagnosis of advanced lung cancer. Even though she was young and had been healthy, the disease spread to her bones.  I outlined treatment for this incurable illness: choices, goals and side effects. This was a very tough meeting, because by the end we had to discuss time as measured by dollars. The particular challenge was that this family had health insurance ...

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You are taking care of a patient with metastatic pancreatic cancer.  The disease has spread, surgery is not an option and second line chemotherapy has failed.  He is in pain, but is poorly compliant with narcotic directions.  He keeps falling down the stairs.  His wife cries all the time.  The family is desperate for help. The patient is in the office with loved ones, looking for guidance. “What do we do ...

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Recently, I continued my crusade to make end-of-life care a basic skill, as I gave the "Introduction to Dying" lecture to third year medical students, for the twentieth time.  For me it is not just about pain control, family meetings and hospice care, but rather convincing physicians that they must change the medicine practiced for the last 100 years.  That medicine says that a doctor can fight all disease, give any treatment, ...

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