Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of ...

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Dear Husband, MD I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next "shift." I put quotations around "shift" because we both know you will not work 8 ...

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Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public ...

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Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing at Blair General Hospital. Thanks to my mother, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B, and he was a legend in my home state of North Carolina. My mother was a ...

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It used to be that hospitals billed Medicare for the services they provided, and Medicare -- I know this is crazy! - simply paid the bills. Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare ...

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In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have ...

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Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know ...

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In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals:  “Isn’t it hard on your kids not to have you home on Christmas?”  Thankfully, I was always able to answer truthfully, “no.”  With consistent effort and a no-nonsense attitude, my kiddos either didn’t know the difference because they were ...

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For any health care professional, a typical day in the hospital brings about its unique challenges. Depending on the patients that we see, one second the situation can be routine, and the next second, it can become complex. In the midst of this flux, there is an expectation for us to make important decisions, with the speed of these decisions dependent on how a patient is doing at a given ...

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With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace:

Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back ...

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