I assumed she asked because besides being a hospice volunteer,  I was a medical student and wouldn't get spooked by a dead body.  She probably didn't realize that it was my first week of classes, and I hadn't experienced much yet. She walked into the room with her head slightly bowed forward.  She was physically and emotionally exhausted.  Because of a scheduling snafu, there was only one nurse for the entire ...

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shutterstock_192230474 The American Board of Internal Medicine is irrelevant.  It has always been.  I realized this when I first certified in internal medicine in 2002.  The test was largely fact-based and filled with information that I would never need to know in practice.  It did not measure my diagnostic acumen, or my physical exam skills, or my ability to listen and empathize ...

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I remember being more confident that most of my peers.  The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me.  Maybe it was on account of my lifelong pursuit of medicine.  I felt nothing but elation at the newly branded "M" and "D" that came after my name on the hospital badge.  I was no longer a volunteer, no longer a ...

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I used to think that there was a communication gulf between doctors and patients.  Somewhere in the hubbub of the harried office visit some secret sauce was missing.  A divide that was so fundamental that both parties often left the room feeling disjointed and uneasy.  Patients wondered if doctors truly heard them.  Physicians wondered if anyone was listening to what they were saying.  The tension ebbed and flowed but never ...

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Behind every doctor is a little boy or girl who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet.  She swore that when (if) she got older she would protect the innocent from such things.  Her vow was the ...

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shutterstock_141318316 I understand that there is a difference between perception and reality.  I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status. Nonetheless, I am amazed at how history seems to repeat itself.  Year after year, while sitting in the shade and relaxing by the pool, ...

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Loss is something all humans face in their everyday lives.  As a physician, the effects are often magnified.  People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere.  Parting can sometimes bring relief, and others a deep sense of failure.  But with Clara, I'm not sure we actually parted.  Mostly, I was left with confusion. Clara came to me by way of the nursing home.  ...

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Neither of the two most important people in Aaron's life could stand to be in the same room with each other.  There was a long colorful history between his ex-wife and his brother, and as his disease began to accelerate, the feuding became quite intense.  They argued over Aaron's advance directives.  They both tried to coerce and manipulate themselves into commanding positions.  The shouting became louder, the fury more fierce.  ...

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shutterstock_146645084 Physicians are docile.  We are programmed to put the greater good above our own.  We train mercilessly, work tirelessly, and bend faithfully at the alter of those we have vowed to heal.  This is our birthright.  This is the covenant we signed in our own blood when we took our healing oath.  Decry us as they will, no one becomes a ...

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shutterstock_172067600 It seems everywhere you look in health care today; some consultant is telling you that "less" is actually "more."  Less care leads to more quality.  Less expense brings better outcomes.  Nurse practitioners with less training are more cost effective.  Fewer work hours for residents builds a safer hospital environment. Never in our entire history have we gotten so much for so little. Arshya ...

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