As part of my medical school’s inter-professional learning, I shadowed a hospital chaplain this afternoon. While physicians principally attend to the physical healing of patients, chaplains also fulfill an important role in health care: meeting the spiritual needs of patients. When faced with disease, patients often grapple with deeper questions about their illness beyond just what the diagnosis and treatment plans are. Immediately upon arriving at the hospital, there was a ...

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In my second year of residency, I was on the hematology/oncology service where we were taking care of a pleasant lady in her 80s who was admitted with pancreatic cancer. It was apparent that the disease had spread rapidly, and when we discussed her at rounds, we knew that she likely had a few months to live, at best. We also knew, however, that there were life-extending treatment options we ...

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After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use. While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get ...

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What if each doctor in contact with medical students and residents acknowledge that they are a diverse group with their own inherent strengths and weaknesses? Some residents will have mastered the knowledge within the pages of the textbook and can easily recite it during attending rounds.  Others will have a natural bedside manner making patients feel comfortable, so that the admission history and physical exams are more complete. Others will be ...

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Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December. CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise -- a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company ...

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We are a product of our upbringing.  For many of us, this means we develop values and beliefs about money and work from our parents.  Our communities, however, also play a role.  It is in these communities that we learn a joint value system, a blueprint for how to approach and interact with the world.  It’s easy to underestimate the profundity of this effect. I grew up in vastly different cities.  One ...

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Performance appraisals are an integral part of an organization's assessment of employee and trainee standing. Management and human resource literature is full of analysis and debate regarding how to best rate subordinates. Regardless of evaluation system utilized, some of the common goals of individual appraisals are to monitor progress, identify areas for growth, set goals, guide development, provide and elicit feedback through open communication, and document issues that may require ...

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It is 3:30 p.m. on a Wednesday, and I am bringing my last patient out of the operating room. Everyone is in great spirits: a smooth case and an early finish at our surgical center. The patient has already awakened, stretching his arms, and clearly comfortable. “Everything went alright, doc?” I smile, knowing that I will be repeating what I am about to say a few more times as the anesthesia wears ...

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Across the United States at least forty people die each day from overdosing on opioids like Vicodin, codeine, heroin, and oxycontin. Seven percent of drivers who died in car crashes last year were found to have prescription opioids in their systems -- seven times more than in 1995. Considering these alarming rates of overdosing and DUIs, this is serious business. Authorities view it in their traditional way: the problem is drugs. ...

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In a recent issue of the Annals of Internal Medicine, Terwiesch and colleagues propose “reimagining provider visits as the new tertiary care.” Initially, their arguments seem sound, even reasonable. Then, they conclude with this:

The conceptual change is to see every engagement with a clinician not as something to be celebrated but as a kind of failure — an inability to accommodate patient needs by any of ...

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Health care is obsessed with new technology. Every week, a new article comes out promising disruption of medical care as we know it through personalized genetic therapy, app extensions that transform smartphones into ultrasounds or autonomous surgical robots. Yet, one of the best examples of health care technologies is also one of its oldest — instant messaging. Though the original messaging platform AOL Instant Messenger was sadly discontinued at the end ...

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“Where is Saipan?” I typed into Google to search for this little U.S. territory island in the Western Pacific when I was told about a need for an OB/GYN in 2016. Next, I inquired to the private physician looking to expand his practice, “Do you really have a significant volume to support another doctor?” My vision of island medicine was that there were a smaller number of births due to a ...

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Every day, we’re presented with choices. Some are larger than others, and though some make little difference in the grand scheme of things, some choices can be life-altering. In life and in business, when we have a big decision to make, it’s all too easy to err on the side of caution -- sometimes to our personal or financial detriment. It’s human nature. But what is it that keeps us from ...

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I keep reading about how physician’s rightful bitching and moaning is peaking at an all-time high. It’s time they do so before the bow breaks, and let me tell you — we’re almost there. The worst problem that persists is “the enemy within ourselves.” This voice of doubt keeps us from the next logical step: stop what we’re doing, revolt and disable a broken runaway system lest we all soon ...

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It has become more and more evident with time that the health care delivery system here in the United States is riddled with issues. One with many disagreements arising from the fact that there is no clear and universally acceptable solution to our problems. In many ways, the system seems to step on its own feet — as the health care professionals working within it fight to make it work ...

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It's 2:02 p.m. when my pager beeps. I pull it out and read: "Juan may have just passed. Going in now." As a social worker in the region's only cancer specialty hospital, I provide emotional support for patients and their families — including talking about their wishes for end-of-life care. Juan is a sixty-five-year-old Ecuadorian man with stage 4 pancreatic cancer. I've known him for about a year. Polite and easy to ...

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Opioids are an essential class of drugs used in pain management. In recent years, complex mechanisms pertaining to their abusive use have prompted a deadly crisis which is unfolding in the United States. The U.S. Centers for Disease Control and Prevention stated that 91 Americans lose their lives daily due to an overdose of opioid drugs. This public health crisis has inspired much apprehension even among Haitian ...

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If you haven’t noticed, Americans love debt.  The average household has around $130,000 in total debt, including $50,000 in student loan debt, nearly $30,000 in auto loans, and $16,000 in credit card debt. With an average credit card interest rate of 15%, that would be $2,400 in interest per year. With a student loan interest rate of 6.8%, that would be $3,500 in interest, ...

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For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors.  But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon.  This is our friend Clostridium difficile. According to the CDC, there are about ...

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Remarkable improvements in advanced life-saving therapies have brought chronic disease management to the forefront of American health care. Today, we see more patients that have complicated conditions. Often, these patients are admitted to the hospital with acute symptoms related to chronically managed conditions such as heart failure, lung diseases or cancer. These patients can end up in the intensive care units and require critical care such as ventilators, dialysis and other ...

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