A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty. When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate ...

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Sophie's Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp. While not of the same gravity,  I have seen the discussion by policy wonks about physician payment reform ...

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Several years ago I wrote an article for physicians on the topic of balance, and one of the suggestions was to place family first.  There are two stories that I have learned since the publication of that article that I would like to pass along. Balance in a doctor’s life is best achieved if there is balance between family and work.  One of the best suggestions is to place family ...

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"Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.” Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final. “Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.” I ...

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Burnout: The perfect storm of physician stress To the literal-minded, burning out is the fate of light bulbs and matches.  But whether you read the popular press or medical journals today, you’re likely to find writers who are deeply concerned about physician burnout. What defines physician burnout, and who exactly is suffering from it?  Is burnout an actual clinical syndrome, a slang term connoting fatigue and boredom, or a hazy ...

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Are we unfair to the RUC? A view from the insideA guest column by the American College of Physicians, exclusive to KevinMD.com. I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I'm an alternate, but ...

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Don’t ask me nothin’ about nothin’, I just might tell you the truth.  – Bob Dylan I just read an interesting post by Dr. Jennifer Gunter. Apparently, the entirety of what we are doing here at Dr. Whitecoat, and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training? According to ...

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As a little boy I had a dream that I have always wanted to join the circus.  I thought for sure I could be a clown or even the ringmaster.  At age 34 a friend who did public relations for Ringling Brothers and Barnum & Bailey Circus gave me the opportunity to make my dream come true and I was invited to be a clown in the circus. The show was to ...

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If you are a healthcare provider—physician, administrator, or some other leader at a healthcare site—then you know that you face many challenges.  Some seem overwhelming and you may be thinking that you may not be able to handle some of them well.  Perhaps the transition to ICD-10 coding is your main concern right now. The solution to difficult challenges begins with the first step.  I am taking the liberty of adapting ...

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When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly. This is why I think it’s worth listening to doctors who no longer practice medicine. Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about ...

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