Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness -- many are still ashamed to admit to it, and the stigma is far from being annihilated. Nowhere is this stigma more entrenched than within the medical profession itself. A fact that should shock us out of our judgmental slumbers ...

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I was spending time with friends and family over the holiday when I started to experience various vague symptoms without an obvious etiology. Having been treated for high blood pressure about ten years prior before successfully overcoming the issue with exercise, I immediately recognized the return of the condition. (As an aside, it should be stated that elevated blood pressure typically produces no symptoms at all.) Stopping by my local pharmacy, ...

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There's a code among physicians, both in the private and academic setting. It is that, as a physician -- unless you are dying, or very close to it -- you show up to work. Taking unscheduled time off, for either physical illness or grieving, is not easy as a physician. Doctors experience a huge amount of guilt and pressure, and rather than experience that, most of us will drag ourselves ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I have a “like-hate” relationship with clinical metrics, performance measurements, and other such things. By now, almost all physicians live with them in the form of insurer “report cards,” PQRS, and “meaningful” use. Some of us have even more exposure to them by participating in ...

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There’s stress written all over their faces. Poised in that precarious time of life, transitioning between the teenage freedom years and the responsibilities of adulthood, those six first-year medical students look anguished. Their collective eyebrows knit together. I’ve given them a challenging homework assignment: “Write a 500 to 1,000 word essay and read it to the class next week.” “I’ve got a question,” J says. “You told us to write an essay about ...

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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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