In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on. I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the ...

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I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made ...

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Once a month, she waits patiently in my exam room, despite the fact that I’m almost always running an hour late in my hectic community health center practice. She is 86 and suffers from mild dementia, diabetes, arthritis and an arrhythmia for which she takes warfarin, a powerful blood thinner. At every visit, she comes to me with some sort of homemade gift -- a scarf, a tin of cookies, ...

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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

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I accompanied my husband to an office visit with his orthopedic surgeon. Jamie had been experiencing setbacks in his recovery from major surgery. I went with him because I understand how hard it can be to distill medical information on the spot, much less remember it. Documenting what the surgeon said would allow us both to reference it later. The more information Jamie had about his condition, the more of ...

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I glanced at my watch before responding to the pager. It was almost 2 a.m., with the end of my 24-hour call as the in-house surgery resident still dangerously far away. The page was for a new consult from the medical service, on a patient with necrotizing pancreatitis. Apparently, she had been in the hospital for over a month, in and out of the ICU with multiple drain placements, and ...

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Have you ever stopped to consider who you are or what defines you? Is your self-worth or self-esteem wrapped up in those two little letters "Dr."? How would you feel if they were removed? Would you know who you are without them? As medical students we work hard, study long hours, sit tons of exams and tests, to ultimately prove we have what it takes -- that we are intelligent enough, to be a ...

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Recently, I was asked to give a talk on spirituality, and it’s importance in health care.  I found myself thinking about how I have spent the last few years focusing on the “easy” fixes with my patients such as diet, sleep, and exercise.  Now, I am not saying that these things are truly easy to fix. However, when it comes to a physician addressing these topics with a patient, talking about ...

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John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain medication and presented to the ER for another “handout” of hydrocodone. He admitted that life was taking its toll, and he was beside himself from aging. Was it time to ...

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I find interesting how much lies in the fate of the day's mood when it comes to forming a new patient-physician relationship. I can have one of my typical days (and thankfully this is usually the case) in which my mood is great; I stroll into work, after having sipped an entire cup of coffee, maybe nibbled on a Moroccan cookie or two, and donned my white coat and stethoscope, ...

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