I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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To say that there is no fear in the examining room is an inaccuracy. I'm not only talking patients here. Physicians may harbor just as much worry and discontent. There are the old standbys of course: The swat team of malpractice attorneys lounging in the waiting room ready to pounce or the old demon of misdiagnosis and the consequences that may follow. Few of us talk about that sinking feeling which ...

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There is a basic communication gap between you and me. How could there not be? It's not what you expect. I say you have cancer, or heart failure, or emphysema. Full stop. A conversation ensues. This is not what I'm talking about. It's more like when I report to you a series of normal lab results, and at the end flippantly mention a slight elevation of the white blood cell count. ...

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You won't at first. But then, you will. It will start innocently. Probably even before medical school. You will have a morbid curiosity about passing ambulances and motor vehicle accidents. Your original empathy for the victim will disappear when you begin to think of them as patients ... as test cases. The commodification accelerates during the early years of medical school. Anatomy, pathology and physiology provide you a vocabulary to replace human ...

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I have a breathtakingly difficult confession to make. A confession that on its face seems rather innocuous but in many ways shakes the foundations of who I always thought I was, and how I identify myself. I no longer love being a physician. There — I said it. I winced even as I strung the words together to write the sentence. You see, to admit this is almost inconceivable. So much of ...

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I bought my first house a few days before starting my second year of residency in St Louis. It was a townhome: two bedrooms, one and a half baths, hardwood floors and lots of wall space. So much wall space, in fact, that I immediately began to look for ways to adorn all those barren surfaces. After visiting some local art galleries, I came to two conclusions. I knew exactly what ...

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Dear Mrs. J, I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together ...

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Mathew preferred using the more biblical term "shepherd." After all, he labored his flock through pastoral pastures and meandering meadows. His parishioners, of course, were sheep and not people. After years of leading them, he could discern subtle differences: the slope of a forehead, the stutter of a step or the variation in bleat. He had a distinct name for every animal in his flock of thousands. Although Mathew preferred isolation, he ...

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The notion began early in computer science class during Jason's freshman year. The professor had noticed a certain elegance and zeal in his work and suggested medicine. That was in the days of the giants when clinicians were tied to such clunky programs as meaningful use and PQRS. In this antiquated milieu, Jason cut his teeth on basic health care architecture. In those prehistoric years, there still remained a bias toward ...

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I both look forward to and despise Sunday mornings.  I awake just before the sun and am on the road by 5:15 a.m.  Although I dread being upright so early on the weekend, I rejoice because it is the only trip to work, all week, at a leisurely pace.  I see the new admits at the nursing home, run by the hospital if necessary, and return just as my family ...

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