As I sat on the edge of her bed discussing delivering options, a sweet mom of twins (who we had decided to welcome to the world at just a few pounds each) looked at me and asked a question that many of us are asked: “What’s safest? What would you do if it were you?" Most of the time we present options as best we can. If one is clearly the ...

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An excerpt from Physician Suicide Letters -- Answered. When is a taboo topic no longer taboo? When is it OK to stop hiding behind euphemisms? When is it safe to tell the truth? The answer is now. This week I uploaded 53 chapters of physician suicide letters in a
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Every primary care physician has had this experience: We refer a patient to a cardiologist, pulmonologist or gastroenterologist and get a note back that says our patient’s symptoms are not cardiac, pulmonary or GI related. “Not my department,” in essence. Medical specialties are organized by organ or organ system, and not by symptom. This really leaves primary care doctors in the default role of being specialists in diagnostics. I often say ...

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It was never his intention that the name would stick.  A decade ago, when he first began working in the restaurant, some of his fellow employees knew that he was formerly a practicing physician and started to call him "Doc."  Although many of his coworkers had since moved on, taking the knowledge of his previous profession with them, his moniker persisted. Doc liked the simplicity and tedium of his bartending job. ...

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"She's ready to push, doc." It's 2 a.m. I've been up for the better part of the evening, doing my part in the process of labor. I groan; I have a full day of clinic patients six hours from now. But these are the wonderful times. These are the times, in the rural hospital that I work, where it's completely and totally about that laboring soon-to-be mom and her soon-to-be child. There are ...

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2015 was a hard year for my father.  He's a remarkably healthy 89 year old, with no diabetes, no hypertension, and (most importantly) he's got a sharper mind than I do on most days.  Perhaps that's a low bar to cross, but it's pretty good for him.  I think this is from all the crossword puzzles he's done over the years. Dad's troubles started around the middle of the year when ...

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Over the past year, I’ve read countless publications concerning the relationship of customer service and patient care. Many have alluded to the fact that customer service in health care is not only unfeasible, but also detrimental to patient care. As a huge proponent of customer service, it was quite natural to take a defensive stand, posturing against these “absurd accusations.” Over the years I’ve learned, quite often the hard way, ...

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The last time I cried was this past May in the brand new National Center for Civil and Human Rights in Atlanta. As I stood in the room where you hear and see clips from the day of Martin Luther King Jr.'s assassination, I was overwhelmed with emotion and began to cry uncontrollably. I was reminded of all the sacrifices millions of people have made that has allowed me to ...

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In 2013, I wrote a post, "How Can Physicians Retire Gracefully?"  Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I thought it was time to revisit my thoughts and predictions. I have been able to keep structure to a minimum. I go to tai chi classes two to three ...

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Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician. During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, ...

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