The concept of burnout is malicious and dangerous. Terminology like that removes blame from enormous structures that systematically cause harm and put fault onto the victim. It says: "No, the health care system isn't inhumane, you just aren't strong enough to handle it." That word makes physicians doubt themselves and each other, hating themselves for not being "strong" or "tough" enough in a system meant to provide compassion and care. This ...

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It is 80 degrees in the exam rooms.  The air conditioner is broken and despite calling and alerting our clients, almost none of them want to reschedule.  I finish writing up a chart in the treatment room where the air conditioner from the kennels still has some influence.  Despite the temporary respite from the heat, my skin is still glistening with a thin layer of perspiration.  I look sullenly at ...

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The Affordable Care Act has been touted as the answer to our country’s huge uninsured epidemic. There is no denying the fact that millions of uninsured people signed up for insurance through an expanded Medicaid program, which is called Medi-Cal in California. The blessings of a decrease in uninsured patients makes for a great sound bite and has been repeated over and over in the media. The only problem is ...

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Medical student Jamie Katuna brilliantly encapsulates the state of medicine via spoken word. Here's what she says: the state of medicine now does not appeal to me lousy crowded inhumane insane how we treat those in pain they're confused they feel abused used by a system they didn't choose coerced forced to be treated like another digit a statistic, a misfit, what is this? in our quest for efficiency doctors must work relentlessly endlessly till they are spent, and see no satisfaction no chance for compassionate action they can't thrive just ...

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I saw a new residency graduate post about how balanced she will choose to be and how not taking work home would keep her idealism alive. Like a woman who has been pregnant and gone through delivery and postpartum, I wanted to tell her the truth about how emotions get changed in practice and how the emotions become physical ailments at times. I wanted to tell her birthing and raising ...

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Around the U.S., millions of college age kids head back to start their fall semester in college. Their courses carefully selected months ago and their packing completed in a frenzy of activity. But, little thought is given to the most violent crime that happens on college campuses: rape and sexual abuse.  Estimates show that approximately 25 percent of college women have been victims of rape. In fact, ...

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“If physicians aren't happy, they can't heal others” - Vivek Murthy Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians ...

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Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations.  Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: https://twitter.com/ASlavitt/status/768908822081667072 The link in the tweet is to a press release.  The link in the press release citing more details is to another press release.  There’s little in the way of analysis or data about how ACOs did in ...

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EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks. 1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand of epinephrine auto-injector, has been under a lot of pressure lately to back off their unseemly price gouging. They’ve introduced a savings card that claims to lower your ...

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You are currently on inpatient wards and notice your chief medical resident has been demonstrating erratic behavior, frequently muttering about MEN syndromes and antibodies associated with rheumatologic diseases and has been reciting gene translocations. What is the most likely cause of her symptoms? A. Hospital-associated delirium B. Conversion disorder C. Symptoms related to completing an excess number of multiple choice questions in preparation for taking internal medicine boards If you guessed C, you understand what I have been going ...

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