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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I was standing outside of the patient room with two family members, a faithful wife, and a devoted mother. In the sea of faces that surrounded his bed on a daily basis, these were the two that stood out to me. For this young man in his 30s who was battling metastatic colon cancer, his wife, and his mother were his strongest advocates, constantly seeking answers about his prognosis and ...

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"It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended." – Joan Didion, Goodbye To All That So it feels at the end of residency. Of course, there is a graduation date. ...

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It’s likely that you or someone you know has attempted to purchase tickets, or at least talked about the difficulties of purchasing tickets to Broadway’s most popular show, Hamilton. While participating or overhearing the discussion, the conversation has likely pivoted to how expensive ticket prices are on the secondary market. It has become so difficult to get tickets through the box office, even with the partial block ticket releases that ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. “Before we end the meeting, I would like to thank our staff, without whom none of this would have been possible …” I can’t count how many times I said that or something similar when I was the American College of Physicians’ (ACP) Rhode Island ...

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Follow-up appointments at my continuity clinic have given me the opportunity to look at my clinical judgment in snapshots.  Unlike on my inpatient rotations, where I see the same patients every day,  I have to wait for a month or two to see if a medication is working, or if a patient is satisfied with their progress in physical therapy.  Sometimes I have a crisp memory of my clinical decision-making ...

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A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury.  Thank you for your insightful article and feedback.  You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.”  You (the patient) and me (a physician) are now in the same boat, headed the same direction with the ...

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It sounded too good to be true when I first heard about Theranos, a company that promised to revolutionize medical testing by making it possible to perform dozens of tests on a single drop of blood, rather than the several tubes that would typically be required. And that wasn't all. Theranos CEO Elizabeth Holmes, a Stanford dropout and media magnet whose wardrobe seems to consist solely of all-black outfits, promised ...

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I have a love-hate relationship with the no-show patient.  Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my ...

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