“Your zip code is a better predictor of health than your genetic code.” A picture of this quote was projected onto the screen during our lecture. Our professor’s words echoed throughout the auditorium as he described the importance of understanding the social aspects of our patients’ lives rather than just their genetic predisposition to disease. Understanding the social and economic conditions that impact health, disease and the practice of medicine lies ...

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“Dr. Fraser, the pharmacy is on the phone for you. Line one.” I answer the call, pressing the gray, rectangular button with one hand while writing in a patient’s chart with the other. “Sarah Fraser speaking.” “Oh, hi, Doctor, we just got in a prescription of yours, but we are not quite sure what it says.” The pharmacist is gentle in her words. It was the first time this had happened. I’d promised myself ...

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My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!” He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with ...

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I spent 20 minutes listening to Michelle and asking her questions to understand why she was not taking her insulin as recommended. The appointment was for 15 minutes, 5 of which were used by the medical assistant who had to check the vitals and “do an A1c.” I did not ask Michelle whether her feet were tingling or numb. I did not ask ...

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Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer.  Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy.  In the film version of the play, which stars ...

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Scientific evidence pointed to an extremely poor prognosis. Numbers and statistics emphatically declared her imminent demise. My 33-year-old patient was not going to survive. The physicians presented the data to the mother and recommended withdrawal of care, but she remained indecisive. She struggled for two days with the possibility of her young daughter dying. Her child was in the critical care unit in a vegetative state. It was a parent’s worst nightmare. I took ...

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The recent celebration of Employee Well-being Month got me thinking a lot about how physicians are treated as employees with regard to well-being. There is a general consensus that the issue of physician well-being needs to be addressed at both the level of the individual physician and the level of the system in which physicians work. Unfortunately, this insight has thus far failed to lead to significant improvement in the overall ...

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"Doctors are not the problem. Patients are." Anyone who has ever thought the above statement is true has not tapped into the vast well of knowledge and intellect found in their own patients. Training patients to be better patients brings the joy of medicine back into your practice. All of us, at one time or another, sat in a classroom. The teacher spent the first day going over the rules of the ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Recently, I’ve been thinking about how physicians express condolences. This weekend, I attended calling hours to visit with the family of a recently deceased patient. As I drove back from the funeral home, I tried to recall when I started to attend my ...

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I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine ...

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