It is easy to lose oneself while swimming in a sea of medical facts surrounded by overburdened physicians and high-acuity cases. Initially, it is difficult taking care of one patient, much less a whole service. The transition from student to student-doctor is not as homophonic as the semantics would suggest -- and this transition affects the mental health of thousands of medical students each year. Medicine is less a profession and ...

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Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years.  I count him as a protege as we worked together during his residency.  As a clinician educator, we work with many interns and residents, and sometimes we develop lifelong relationships.  Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine.  We periodically communicate through ...

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The title of Noam Scheiber’s January 9, 2016 New York Times piece on hospitalists, “Doctors Unionize to Resist the Medical Machine,” skirts the bigger issue for doctors, which has less to do with contracts, salaries and labor relations, and much more to do with the question, “Is health care just another business, and if so, can physicians be managed that way?” I’m a silverback hospitalist, and when I started ...

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“Fifty-three-year-old homeless woman with diabetic ketoacidosis and severe emphysema exacerbation.” And suffering from adomicilia, too, I added in my head. Much like apraxia­ means the inability to perform purposeful movements (praxis), adomicilia jokingly means those who are not domiciled, a pretentious attempt at gallows humor in the medical profession. I read through the patient’s electronic record imagining a withered woman, wrinkled from years of drinking and smoking, perhaps with signs of schizophrenia. Most ...

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The American health care system is set up to care for a certain subset of the population -- sick people -- people with chronic disease, acute illness, acute injury, and complex disorders like cancer or metabolic issues. The problem is, this set up doesn’t create market incentives to care for the well effectively, or to identify those at risk for disease and efficiently and reliably intervene, at scale. To reconcile this cognitive dissonance ...

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I have been practicing family medicine as part of a large urban managed-care organization for about 15 years now. As part of my practice, I teach medical students and residents. And as a card-carrying member of Generation X, I often find myself right in the middle of the ebb and flow of the work-life balance and physician wellness discussion between my older Baby Boomer “workaholic” and “pay-your-dues” vocation-driven colleagues, and ...

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Part of a series. Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become ...

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I met a woman today who was well-groomed, articulate, insightful and undeniably intelligent. She provided succinct responses and understood the matter at hand. Our ability to treat her, though, will likely be derailed in two weeks when she will once again become homeless. In the midst of a booming job market in my area lies a cluster of people who are unable to find work -- either due to transportation issues, not ...

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My newly admitted patient was at the end of a very long struggle with a devastating genetic disorder. He had been treated by some of the finest experts in America for his rare disease, and had come to my rehab unit for aggressive physical and occupational therapy. He was exhausted, but mustered the energy to tell me (probably the 100th physician to treat him) his complicated story. Listening to this man, and ...

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"It's more important to know the patient who has the disease, than the disease the patient has." This was true when Hippocrates said it 2,500 years ago -- and it remains true today. Unfortunately, doctors no longer know their patients. GPs are overworked, underpaid, and must shuttle patients in and out of the office in less than ten minutes. Specialists tend to treat the test, not the patient, and earn their ...

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