“Doctor, I am ready to die.” I knew her from a few years back. This patient of mine. I am a hospitalist and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different.  I saw her once many years ago when she was gravely ill, and we managed to pull her ...

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A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black. There is the usual array of standard medical characters -- the inexperienced new residents on their first day at work, the savvy nurses, ...

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A long, long time ago, hospitals existed to admit patients when they were sick, treat them with medicines or surgery and good nursing care, and discharge them after they became well. Hospital care was at one time a charity, which evolved into a nonprofit service, before it became a very big business. In olden days, nonprofit hospitals charged patients straightforward fees for their services. Then, when you were just a young whippersnapper ...

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If you weren’t aware of the prevalence and severity of diagnostic errors, (misdiagnosis, missed diagnosis, delayed diagnosis) maybe you should be now. The Institute of Medicine (IOM) released a new report called, Improving Diagnosis in Health Care. The report cited that most people will experience one or more diagnostic errors over their lifetimes. It also revealed that diagnostic errors contribute to 10 percent of patient deaths and account for up ...

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If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000! That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit ...

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I softly scrub blood from the teeth of a man who died moments ago. From the chair where I sat quietly writing nursing notes while he quietly ended, my patient's sallow skin and sunken cheeks looked so peaceful. But the weeks of stagnant residue on his teeth bothered me. To brush the teeth of someone who was in the process of dying would have contradicted my orders to provide comfort care, ...

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He squeezed into the elevator just as the door was closing.  There was a lightness about him, an excitement.  His jacket was newly pressed and uncomfortably free of nicks or stains.   He stood at attention with perfect posture.  There was no sign that working at this early hour on a Sunday morning, nor even being awake, was something out of the ordinary.  Extraordinary. He glanced over at my tattered lab ...

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It’s amazing when events that seem to be “miracles” happen, and even more magical to be a part of them, however peripherally. My husband, David Merzel, MD, a physician anesthesiologist and pediatric intensive care specialist, and his patient, 17-year-old Chiann Wheeler, share the remarkable story of Chiann’s brush with death from sepsis, and how David’s quick diagnosis saved her life. The story began one morning when then 15-year-old Chiann felt so sick ...

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As a physician, you are required to have keen senses.  Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations.  I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia.  Olfactory is a Latin adjective from olfacere that translates “of or relating ...

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An excerpt from Black Man in a White Coat: A Doctor's Reflections on Race and Medicine. On a humid Tuesday morning, Chester arrived at a busy Durham emergency room. While the other patients around him made the usual requests for pain medications, diagnostic tests, and reassurance that they were not ...

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