When I grow up, I want to practice "free medicine.”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?” Free medicine (FM) is a concept I just created in response to a comment from a reader on a recent blog post.  My reader is a brilliant doc, educator and writer who serves both as mentor and ...

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I can always count on Mr. Wonderful to come up with a timely subject for my blog.  Today’s quotable is, “Dear G-d, I have a problem.  My problem is me!” Some days it feels like I spend half my time trying to convince patients that they need to change their ways in order to get healthy.  I often spend the other half of my time treating the effects of their bad ...

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Click, click, click, “Hello, how are you today?” Click, click, click, “How long have you had a sore throat?” Click, click, click, “Have you had a fever?” Click, click, click, “Have a seat on my exam table, please.” Click, click, click, welcome to my day.  Let me introduce myself, I’m a professional clicker.  I used to be a member of a highly respected and sought after profession; a doctor.  The modern world of government/insurer ...

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I’ve been asked to appear on a radio talk show to discuss one of my blog articles.  It seems that the producers of the show were impressed by my article on the beauty of medicine when it works the way it’s supposed to. “When It Works Right, It’s a Thing of Beauty” was published this summer and is one of my favorite articles.  The practice of medicine is a ...

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Today was a great day.  Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing.  Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world.  I know.  I saw it happen today. Today, Mr. X presented with a troublesome history and an even more threatening physical exam.  I was afraid that the disease I was about to diagnose would ...

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Physician Quality Reporting (PQRI) sounds good, doesn’t it?  After all, delivering “quality” is what it’s all about, right?  Maybe.  Maybe the government’s efforts are really designed to improve the quality of the practice of medicine in the US.  Unfortunately, PQRI has fallen short of its reported goal by a long shot. PQRI is time consuming.  PQRI is expensive.  I think PQRI has more potential to do harm than it does to ...

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"Oh, by the way" are four simple words that cause most docs to shudder.  Yes, shudder.  Your patient signed in for a sore throat, congestion, and cough.  The nurse did her job.  She’s recorded the patient’s chief complaints.  She’s taken the patient’s vital signs and readied the patient to see me, the doc. I take a history, asking questions about the problems that brought the patient to the office.  I ask pertinent ...

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How do you define a “good” doc?  I was reading the patient responses to an article here on KevinMD.com and was saddened by how many of the patients were angry with their docs.  Anger is an unhealthy emotion!  One of the respondents was particularly angry about the “unnecessary” tests her doc performed on her and her family. I have written about the vagaries of the term “unnecessary” in the past.  ...

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Here today, gone tomorrow.  The older I get, the more often I get the call: “This is the ER at Any Hospital, can you hold for Dr. X?”  Dr. X then comes on the line and tells me my patient had a catastrophic event, that the paramedics and ER crew did everything possible but that the patient expired. My patient had no reason to die.  He was relatively young and healthy. ...

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Participating in a patient’s first heart attack can be an extremely stressful event. Thirty years ago, I was an ER doc.  At the end of a typical shift, I would come home to my wife and, often, would remark about how nervous family docs got when dealing with emergencies like heart attacks. Thirty years later, I’m the family doc and heart attacks are unnerving.  Yes, I know what to do.  We ...

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