Making a diagnosis is one of my most common challenges. Families and patients are understandably more interested in the therapy to alleviate illness and suffering than exact diagnosis. We are swept along with this laudable therapeutic objective in the current of prompt empiric therapy bringing relief and hopefully confirming an empiric diagnosis and buying time before more definitive testing. I object to this approach even as I engage in it. Necessary ...

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I have come to believe that humility is an essential component of wisdom. Never have I found this truer than in the practice of medicine. In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble. Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact, the label "difficult" assumes the problem ...

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Free speech is one of our bedrock constitutional rights. The battle over what constitutes lawful free speech is ongoing. But the issue is more complex than I can grasp with legal distinctions separating political speech, commercial speech and noncommercial speech. And, of course, the right of speech does not permit the free expression of obscenity or "fighting words" along with some other exclusions. There is no right to free speech in ...

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The patient, I surmised, was the one in the wheelchair with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter. I introduced myself. I had been right about the other woman being her daughter. It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Lately, I’ve been asking myself whether today’s patient is less able to self-manage minor illnesses than their parents or grandparents. That question was inspired by my review of notes from my patients’ visits with my nurse practitioners or to our after-hours clinic, as ...

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There are parts of medicine that are horrendous. Moments too painful to recount, and events that will break even the most innocent participants. And then, there is unspeakable magic. I live for the days when a patient comes to the office with a particularly vexing set of symptoms. Specialist after specialist bows their head in disagreement. Laboratory values whisper falsehoods with jeering tongues. Symptoms are transient, physical exam signs inconsistent and in ...

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As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we ...

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D.J. is a 55 year-old woman with recently diagnosed early-stage left-sided breast cancer. She just had a lumpectomy to remove the tumor, and now has to decide whether to undergo chemotherapy after surgery. Her oncologist carefully discusses the clinical and pathologic data about her tumor, in terms D.J. can understand. She discusses the risks, benefits, and side effects of chemotherapy, and recommends treatment. D.J., having learned about the risks and ...

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In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back. What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical ...

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Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance. Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable. Once DRexit begins, there will be no turning back. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is ...

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