In 2005, my husband and I bought a small farmhouse in northern New England next door to Tom and Sally. They were in their early seventies, married nearly fifty years, with a large family. Tom's grandfather had built a farmhouse in 1900 on the family's small pig farm. In the 1970s, Tom and Sally had parceled off the land and built a modern house for themselves, a stone's throw from the ...

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Over the years, many people have shared with me their disappointment at the lack of acknowledgment from their physician when their loved one died. Especially, when their loved one had been a long time patient of the physician. In fact, many people have shared that they switched physicians because of what they perceived as a slight. When people go to a physician for many years, especially the family physician, it is ...

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Today, I hesitated to refer a patient to hospice. The patient is perfect for that model of care.  She has strong family and friend supports, multiple opportunities to maintain quality, independence and dignity, and while she has a disease we cannot fix, she will do very well with personal palliation. Nonetheless, I almost did not recommend hospice, because I realize that hospice is going to completely fail to take care of a ...

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Ben's first symptom was coughing up blood.  The cancer had been silently growing for months, if not a few years.  He had no pain or shortness of breath.  The chest x-ray showed a "5cm L hilar mass" and the subsequent CT scan showed enlarged lymph nodes and likely spread to the liver. "So Doc, what is it?  A cancer?  How much time do you give me?"  All these questions on a ...

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From MedPage Today:

  1. Primary Care Pay Bump Unlikely. The 10% pay raise select primary care services received under the Affordable Care Act likely won't be extended beyond 2015.
  2. New Guideline Lowers eGFR for Dialysis Start. New Canadian guidelines suggest that nephrologists can wait to start dialysis in some chronic kidney disease patients until their estimated glomerular filtration rate (eGFR) drops below the 10 to ...

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“No Margin No Mission” was a common saying when I studied about non-profits in business school. No matter how good your intentions are, whether it be creating new systems to get people access to care or opening a new animal rescue, if it couldn’t pay for itself it wasn’t going to happen. So it should come as little surprise that an up and coming darling of CEOs of health systems is ...

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When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard.  Knowing that events are overwhelming and complex, I say,  “Look at each treatment, each action and each moment and ask; How does it improve quality of life?”  My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort. For example, most families are very concerned about ...

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Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum.  Her daughter asks if she can be treated with antibiotics "to make her feel better."  The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also ...

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"For someone who went into medicine to 'help people,' you sure do talk about dying a lot," my mother told me one day on our brief weekly phone call. I try to get in a phone call to my mother once a week so she knows I'm alive, surviving my intern year. I had been on medical intensive care unit (MICU) service and it had been a rough week. Being ...

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Whether they are young or old, we do not want our loved ones to die.  Period.  Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void.  I completely understand. But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm.  You see, ...

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