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 to live a sad and angry life. Happy doctors ...

Read more...

Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

Read more...

After 12 years of blogging, I wonder if I should have titled my blog “unintended consequences.” So many rants focus on the unintended consequences that follow from health care policies. The aphorism (falsely attributed to Samuel Johnson) states, “The road to hell is paved with good intentions.” Too often our policy makers, be they bureaucrats in government, insurance company managers or guideline creators, think like a chess beginner. They see the ...

Read more...

Sandeep Jauhar has this wonderful sentence in his New York Times op-ed, "Busy Doctors, Wasteful Spending": "There is no more wasteful entity in medicine than a rushed doctor." And yet physicians are rushed. Dr. Jauhar writes about the payment system driving shorter visits. That problem represents an important component of undesirably short visits, but it is not the only problem. The electronic health record adds documentation time, as do the billing documentation requirements. ...

Read more...

FiveThirtyEight had a provocative article: "Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much." The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have ...

Read more...

Change causes distress for most people. In medicine we have a hierarchy that disdains most change. Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change. Yet change occurs and is necessary. I learned a great deal about change from my mother. This anecdote may help put change into perspective. Many years ago, we lived in a 3 bedroom house. In the evening we all sat in the ...

Read more...

Recently, we had a wonderful reception at the American College of Physician's Internal Medicine 2014. Sitting with leadership colleagues we had a wonderful conversation about how medicine changes. One colleague gave the example of ulcer disease. Those who trained in the 1960s and 1970s know most of this history, but it actually goes back to the early part of the 20th century. Consider the Sippy diet, the Bilroth II, highly selective ...

Read more...

Readers know that I went to the University of Virginia as an undergraduate. Since graduating in 1971 I have remained a huge sports fan and academic fan of the university. Those who follow my Twitter account have seen me tweet often about the basketball team. Our coach, Tony Bennett, took his 5 pillars of success from his father, the famous coach Dick Bennett. While these pillars have a Christian origin, I ...

Read more...

Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, ...

Read more...

I recently presented my diagnostic talk -- Learning to Think Like a Clinician -- at the Virginia ACP meeting.  Afterwards several physicians wanted to discuss the reasons for diagnostic challenges.  They convinced me that many regulations from CMS and other insurers have influenced policies that increase anchoring and diagnostic inertia. When the emergency department physicians admit to the hospital, they have to give an admission diagnosis.  At least in the United ...

Read more...

6 Pages

Most Popular