Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

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All physicians know the scenario. You want to reassure the patient; the patient wants another (usually expensive) test. In our new metric age, we may have a conflict between overuse and patient satisfaction. The article provides some hospitalist data: "Hospitalists know guidelines but overuse tests to reassure selves, patients." How do we balance making our best evidence-based decisions with patient demands? Some experts will tell us that we really have a ...

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During the MOC debate that JAMA sponsored, I was asked what I would do if “I were king” of MOC. As an internist, I believe in first making a diagnosis, then prescribing a treatment. So I have spent time diagnosing my needs as an internist. When I passed my boards I showed knowledge competency. But medicine changes over time. We have major advances and changes since I took my boards. Some examples follow:

Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death. Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. ...

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The most valuable lesson about teaching that I ever learned occurred in high school. I took my first algebra test. The questions were easy, and I wrote down the answers. All my answers were correct, but I got a B. After each answer, she wrote “show your work.” She explained that while algebra questions start out easy, they become more complex over time. Only through careful understanding of ones thought ...

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We all want to practice evidence-based medicine.  Yet that phrase is so overused that one must always question the true meaning underlying the use of the phrase. The first assumption that many make is that evidence is a solid structure without nuance.  Yet we can have different experts look at the same evidence and develop different conclusions!  Why else would we have competing guidelines. Consider this quote from Nietzsche: "There are no facts, ...

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While driving to work, I listened to Mike and Mike (a radio sports talk show). Mike Greenberg made a wonderful point about his job. He described what they do as “professional over-reactors.” They take every game and extrapolate, sometimes irrationally, about the implications of that game. Does this remind you of health reporting? A study appears in a serious medical journal, and the press “blows it up” as the next great advance. ...

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This New York Times article stimulated thoughts about teaching internal medicine: "Better Ways to Learn":

In the new book, “How We Learn: The Surprising Truth About When, Where, and Why It Happens” (Random House), Benedict Carey, a science reporter for The New York Times, challenges the notion that a high test score equals true learning. He argues that although a good grade may be achieved in the short term ...

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Dr. Danielle Ofri has an important piece in the New York Times: "The Physical Exam as Refuge." As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition? While I did outpatient medicine for ...

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shutterstock_85474510 While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine. But that is me, is it you? A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going ...

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