Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café. His maître d' and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his ...

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In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?” “Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming. “You students are ...

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The changes to health care -- not just in policy, regulation, and payment but also the tectonic shifts in how we define, evaluate, report and are paid for care -- can make us all feel like we’re on a runaway train. Alongside the runaway train are the significant improvement opportunities in health care we must somehow address -- less variance, improved patient engagement, coordination of care, adherence to evidence, waste reduction ...

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Sometimes before I go on a run, I take the laces of my jogging shoes and tie them together in a knot.  I wear the pair around my neck with each shoe falling to opposite sides.  The heels clunk against my chest as I make my last minute rounds.  It's as if running is my job and the shoes are the instrument I use to perform that job.  Eventually, I ...

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The American Board of Internal Medicine has been under fire for the excessive testing requirements of physicians and they recently have been seeking clarity for the maintenance of certification process.  In my opinion, the answer is to eliminate the examination completely and create a better, ongoing assessment using CME chosen by the physician that meets their needs, especially in a time where medical knowledge changes so rapidly. Doctors are essentially tested ...

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Recently during rounds on a busy inpatient teaching service at a county hospital, I led a group of medical students into a patient’s room. I asked the same question I have asked well over 10,000 times: "What do you see?" Observation is a powerful tool at the bedside, and offers us an opportunity to learn from one another. My student replied, "I see a white man sleeping in no acute distress." I repeated ...

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Contributors on this site regularly recommend improved doctor-patient communication. Indeed, that's one reason I'm a devoted reader. But we need to articulate exactly what “communication” is. When I ask colleagues about that word, they usually define it as what they say to patients. I can't argue with that. Yes, we need to express ourselves clearly and simply. But communication includes much more. The occasional complaints I hear from patients about their care ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. “I said, ‘Somebody should do something about that.’  Then I realized I am somebody.” - Lily Tomlin Each day, family, work and extracurricular activities all compete for our attention. They are positive aspects of our lives but can be overwhelming at times.  When legislative or regulatory ...

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A response to "You signed up to be a doctor, not a martyr." Dear next patient, I appreciate your letter and your advice. I would sincerely like to follow all your advice concerning exercise, eating right, and spending more time with family. I try to make every effort to do so. Unfortunately, I am in the middle of transitioning for the third time to a new EMR system and managing quality ...

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I’m a physician, part of the enormous all-consuming machine called modern health care.  This machine is driven by value-based best practice and end results. Literal life and death decisions are required daily, so naturally I become impatient when my son can’t decide between chocolate and vanilla or which movie to watch. My cultivated Achilles' heel of impatience has a tendency to interfere with daily interactions or decisions because of the dreaded ...

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