Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan. “Quality.” We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”, “deep-dive” and perhaps even “personalized medicine,” quality has begun to feel like water torture and risks being deprived of flavor or meaning.  However, do not so fooled or bludgeoned that you lose ...

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I was talking with a few friends not long ago.  Our conversation somehow got to the issue of authority, and what exactly respect for authority looks like.  One of them, trying to make a point, turned to me and asked: "So you surely deal with people who don't listen to what you have to say.  What do you do when your patients don't take the medications you prescribe?" I think he ...

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My most important patient requires my constant diligence. For this reason, I am seldom far away from him. Only a few minutes inattention and there will be problems. I cannot forget my patient; I am trained to attend to him constantly. I am a professional, and my patient is, ultimately, my customer and the customer’s service is paramount, I am told. I am reminded by policies and procedures as well, ...

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When he turned 45, Mitch Alsup bought a red Corvette. Mitch is a quick-talking guy with dirty blonde hair and a short, trim physique. He has a ready smile and is willing to share his story. “As a kid, I use to go down to the Chevrolet dealership and sit in a Corvette,” he recalls. “I wanted one when I turned 18, but I came from a poor family. I had to ...

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When was the last time you used heroin?  In the past have you injected heroin or any other drugs?  Are you currently using drugs besides opiates like methamphetamines, cocaine, benzodiazepines or alcohol? After two years of family medicine residency, I ask these questions like they are questions that everyone asks in a casual conversation with a patient.  Although these types of interviews are customary for me, I recognize that it takes ...

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For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors ...

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I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around. When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify ...

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As a registered nurse and health care writer and editor for more than 25 years, I routinely wrote or assigned stories to other writers about the health of LGBT individuals.  I valued these stories not only because I was a nurse, but also because I thought the subject was worthy of coverage. I believed our nurse readers should be aware of the specific health needs of their LGBT patients. I followed ...

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When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much. Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was ...

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