Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end). He pointed out that it ...

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Once upon a time long, long ago there lived a man who could see things that other people simply could not see. He was not born with this skill but cultivated it slowly and continuously with years of focused attention. He worked as a physician in a large hospital and would sometimes have students go with him to see patients. As far as the students were concerned, he could really see ...

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As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day now. I was sure that she knew that something was wrong but did she know that she’d be dead in a few hours? One of the most profound things about being a ...

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The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there's free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We're prepared to handle them. "Where is the patient?" I inquired. "On the way down from ICU. The surgeon's on his way in," I was told. Hmm … ...

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One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as ...

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Three weeks ago, I changed jobs.  I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital.  Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting. I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I ...

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The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice. Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any ...

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One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, ...

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This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital. I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and ...

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As a member of the general population, we see physicians as those who were born with a calling. Though society acknowledges that becoming a doctor is difficult, it is near impossible to fathom exactly what that title entails. I was raised in a small rural community in which resources were quite limited. The nearest grocery store was a 35-minute drive away, there were no coffee shops or traffic lights, and we ...

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