It is not uncommon for doctors to question the reasons why we do what we do.  The journey is long. The debts often seem insurmountable.  The harsh lessons learned from a mistake made with best of intentions are an unforgiving punishment for “life without forgiveness.” Memories may fade, but the scars always seem to linger. On the one hand, like a relief pitcher in major league baseball, we must forget ...

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Earlier this month I read a Wall Street Journal article about Zeynep Ton’s Good Jobs Index. Who is Zeynep Ton? She is a professor at the Massachusetts Institute of Technology’s Sloan School of Management who has ranked retailers on employee happiness. This was so positive. It was good to hear about businesses concerned about employee happiness and not just about profits and shareholders. Two weeks later I was dismayed to ...

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It was a week into my elderly patient's hospital admission when he began to have fever and profuse diarrhea, some 10 to 12 bowel movement a day. The diagnosis was not hard to make: a stool test showed he had C. difficile. Another patient, a thin women in her late 40s who had become paraplegic after a gunshot wound decades ago, came in from a nursing home when her urinary catheter ...

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Recently, I spent two days in Greenville, SC as a guest lecturer. During that trip, I had time to chat with some hospitalists. During our conversations, I explored a classic problem: the inpatient-outpatient handoff. Talk with hospitalists and you will discover their angst about getting outpatient information on their admitted patients. Talk with primary care physicians and they echo the angst when seeing recently discharged patients. Personally, I have experienced both sides of ...

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How special is it that, as medical students, we are involved intimately in the lives of strangers? We get to be eyewitnesses to their most vulnerable moments, both celebrating the joy of new life and mourning the loss of loved ones. Students on their OB/GYN rotation triumphantly update their Facebook statuses with their first delivery of a baby, a new soul who will grow up not knowing how special they are ...

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“I want to explore employment opportunities with you.” He is looking at me. Trying his hardest. Passion, yet anger, in his eyes. Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is. Private practice is dying, on the vine, in America. The practices fold or reach a critical point, and they come ...

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"I'm just the night doc," you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was "just the patient," who lay suffering hours before her death and the RN was "just the nurse" withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to ...

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I just finished my first call weekend as an attending. It was a 96-hour bender. I had 4 vaginal deliveries, 1 cesarean, rounded on 20 patients on Saturday (mostly new), 14 on Sunday. I admitted 5, transferred 2 out --one for persistent ventricular tachycardia and one for a possible liver abscess, all while juggling full days of clinic on Friday and Monday. After the call, I felt tired, but still felt ...

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shutterstock_124488283 As a relatively young physician, I always enjoy my conversations with the older members of our profession, who’ve seen so much change over the last few decades. I’m fascinated with their stories about how different the medical world was when they were residents, how treatments were so novel, and how they used solid clinical skills to get to the diagnosis. Those were the ...

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“This is our sickest patient,” my co-intern began as she told me about one of her patients I would care for overnight. It was my first week of intern year, and I was assigned the overnight cross-cover shift for a busy cardiology service. Introducing myself as “Dr. Tredway” still rolled awkwardly off my tongue, but I had grown more comfortable throughout the week in my new role as a physician. ...

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