Last week I finally got around to watching La La Land. As a fan of musicals, I had wanted to see it for quite some time, and before I stepped into the theater, I didn’t know what it was about nor what kinds of reviews it had been getting. Spoiler alert: Don’t read on if you haven’t seen it and intend to watch it (and I’ve never told anybody before ...

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His voice was gruff and his expression surly. "I don't want any more medications." His face was indented by deep clefts, remnants of eight decades of life hard lived. His tone was commanding and certain. I knew that he was fond of me, but I could feel his patience slipping. He neither asked about nor accepted his diagnosis of heart failure. I could tell him till I was blue (or he was ...

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Attention all nurses, nurse practitioners, physician assistants, midwives, doctors and anyone else in health care: Here are the top 10 warning signs that it is time to quit your job. The first three are mine. The rest are from colleagues. If you recognize anything on this list, please quit your job. 10. You feel nauseated when you see your clinic logo. You alter your commute to avoid streets with your clinic’s ...

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Transparency -- including price, quality, and effectiveness of medical services-- is a vital component to lowering costs and improving outcomes.  However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in vain.  The single best way of reducing costs while not worsening health outcomes is to redistribute resources from less cost-effective health services to more cost-effective ones.  Americans are extremely uncomfortable ...

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The phones, the phones, the phones. Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can't lick, a continual thorn in the side of our practice, something that's hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without ...

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  Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment. Physicians work hard to diagnose and treat their patients, ...

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Once upon a long 18 years ago, I got sick. I was sick from a growth in my brain. The growth was found after I'd shuttled from doctor to doctor, from appointment to appointment, from X-ray to scan. It took a year. By then, my pain was clothed in shame. Undiagnosed pain does that: It draws the gaze of friends, family and providers. Everyone looks for the cause. "Soul pain," said one doctor. ...

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It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you'll wonder why you didn't get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you'll let it go and move on. Or so you think. Until during surgery when the scrub nurse ...

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The young woman sat in the corner of my exam room, facing away from me as I asked her questions. Her answers were short. "I’m from El Salvador." Why did she come? "Because of the violence." Her voice was flat. Her hands trembled. I knew she had suffered terribly and I needed to ask her how. Slowly, quietly, she recounted the gang violence she had fled in El Salvador. The assault ...

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When I was growing up, RuPaul was all I knew of transgender anything.  She was tall, flamboyant, charming, and I would look at her and try to see the man underneath the drag.  I didn’t know the definitions of drag and trans, gender identity and intersex, ambiguous genitalia and gonadal dysgenesis. Now that I’m a physician, I see transgendered patients on a regular basis -- unfortunately, it’s usually in the setting ...

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