There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this ...

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Sometimes the health care system just does not work. I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two ...

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The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients. Perhaps because it is (happily) not a daily event, or perhaps because it is so much more personal, clinicians do not talk much about what they have learned from being a patient themselves. The other end of the stethoscope is a good place to learn about medical care. During the diagnostic phase of my ...

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As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let ...

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"The best defense is a good offense." This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths. During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors. “So, tell me, I know it’s hard to manage both full time school and a part ...

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William Osler famously said (among other things):  “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in  my skills and knowledge than was justified.  Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery ...

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Shortly after 3:00 I was listening to Chloe’s precise clinical description: her daughter, Mysti, had been fine and "in her usual state of rambunctious health" despite a runny nose and a low grade temperature of 99.8 to 100.6 that mom had not felt warranted treatment because she was eating and drinking and playing normally, and sleeping despite a very mild cough when she lay down. That morning she had noticed a ...

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