shutterstock_124482742 The insurance company insisted that they would be saving money in the end.  So they sent the PA (physician assistant) to my patient's house.  They didn't take into consideration that I was just there a week before.  Or that I made home visits on a regular basis.  In fact, they didn't even inform me about the appointment. My patient later told me ...

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When I began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms.  How else could I explain my patient's willingness to suspend all social rules and norms upon passing through those magical doors?  They would sit down in front of their baby faced-doctor and talk about things.  Private things.  Scary things. Conversations occurred that would be unthinkable if two strangers were to ...

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Loitering in the hallway of my son's school awaiting his parent-teacher conference, I completely forgot that the woman introducing herself and shaking my hand was an alcoholic.  I forgot that she had visited me in the office a decade prior for a consultation.  I forgot all of it. What I remembered is that we had gone to high school together.  We had grown up in the same city, in the same ...

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The whole thing was rather awkward. I have to admit that I was nervous. I perused the records before he walked through the exam room door. These conversations were always difficult and felt out of place in the office. But I had looked at the numbers over and over again. There was a glaring deficiency that had to be corrected. I planned to jump in right away, but we got sidetracked. He ...

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shutterstock_148398755 We both agreed that it was unfortunate. I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks. His business flight was interrupted by severe spasms of cough and high fever. He called me upon landing, and based on my advice, went to a local urgent care center. After ...

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shutterstock_210331261 It's metoprolol. m-e-t-o-p-r-o-l-o-l The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering. I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal ...

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Everything eventually expires. I looked down at the bottle of natural spring water in astonishment.  It had an expiration date.  Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad?  It had no living parts,  Nothing that serves as nourishment for wayward bacteria or fungus.  The container was sealed.  Pristine. I figured it was another fiscal hoax, perpetrated on unsuspecting consumers.  ...

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shutterstock_222269452 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 ...

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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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