I went to the retired firefighters dinner last week and had a great time, probably because I happened to land on a table full of contemporaries: men who worked at pretty much the same time I did. Inevitably, conversation turned to our memories of some of the older firefighters we had to deal with as we worked our way up the seniority ladder; "getting time on" is what it was called.  ...

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shutterstock_122870008 On Valentine’s Day weekend last year I found myself at Paddles, the local dungeon in New York City’s Chelsea neighborhood, for the first time. I was perched at the alcohol-free bar when a man politely introduced himself as a human carpet. He asked that I tread on him and lay on the floor to demonstrate. A professional dominatrix-in-training stepped onto his ...

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Incentive structures in health care have to change. Right now, we pay for services, or have a so-called, fee-for-service system. The idea is that the more patients doctors see, the more expensive tests doctors order and the more patients doctors hospitalize, the more money clinics and hospitals make. This incentive structure has transformed our health care into sick care. The reality is, in America, we are adept at caring for complicated medical problems that require ...

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Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves.  – Genesis 11:4 With these words, so begins the biblical story of The Tower of Babel. The tale was written, at least in part, to explain the origin of different languages. Essentially, a group of earth’s early inhabitants started to build a tower to the sky in order ...

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Abuse-Schedule-476x640 A physician in Texas posts this photo on Facebook. Caption: “My schedule one morning in January 2014. Never again ...” Yay! Another physician breaks free from assembly-line medicine. High-overhead, high-volume offices sacrifice the sacred physicians-patient relationship and perpetuate a disease-billing management system. This is not health care. It’s abuse. Patients: Avoid clinics with 10-minute slots. Go for docs who offer 30 to 60-minute appointments. Physicians: ...

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The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab. Printing a requisition from our EMR is a multi-step process that involves ...

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Many of my patients are taking herbal supplements, or so they think.  This herbal and health supplements industry likely is envied by traditional pharmaceutical companies.  The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA).  Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer ...

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I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice.  This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most ...

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blueandblackdress2-770x457 My mother-in-law texted me about The Dress, random friends are blowing up my inbox, and the nurses in the emergency department were huddled around the computer at 2 a.m. debating the color of the dress. Everyone in the world seems to be wondering what color the dress really is and why. The best way to find the answer to such questions is to find ...

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shutterstock_127360631 I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues. We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor. It has taken us a long time to get here. Let’s do some ...

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