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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I did not need help. I could do it myself. I never asked, and anyone who worked with me quickly understood they did not need to offer. This was my modus operandi. It was how I unconsciously organized my life, no more aware than riding a bike or tying my shoes. It happened in the background — utterly unknown to me for many, many years. I could see “side effects” of this ...

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Anyone who has ever tried to buy health insurance in the open marketplace knows how difficult and expensive it can be. I spent years working at jobs that did not provide health insurance, and I remember the annual feeling of dread when I received notice of the new premium increase. The only way I could keep the cost affordable was by continually raising the deductible until eventually, I was paying ...

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When I started medical school over four and a half years ago (I took a research year), I knew that primary care was my passion. I actually had a dream beyond medicine to be a liaison of sorts between the ivory tower of medicine and the community. Once I stepped onto the scene of my medical school, things started to change. My goals stayed the same, but I started to ...

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Camille’s dark glasses disguised a black eye she suffered falling from bed, cowering to take cover. Someone fired shots near her bungalow’s back window again, a routine rhythm of her slice of Chicago that she has heard for years now. The 82 year old walks with a cane but carries a brick in her purse. She’s not afraid to use it on a badly behaving neighbor. Most would think she has more ...

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Many physicians don’t want to think too hard about investing. There are a lot more fun things to do in life than worry about the minutiae of index funds. One of the best investments for beginner investors are target-date funds. It’s a great way to get started with investing, while you learn more about the principles of asset allocation. But there are literally hundreds of target-date funds available. How do you pick ...

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A patient with chronic pain and a physician walk into an exam room. This could be the set-up for a punchline, but in our current medical climate, it's more often the first step in an elaborate dance that leaves both parties feeling frustrated, belittled, and ignored. Often, this is a first-time appointment rather than an established therapeutic relationship. From the patient's perspective, here's what happens: They've been putting off this visit for ...

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As a medical student, I have big shoes to fill. I feel that void in my foot-space at all times. These shoes are expensive, and they are monstrously huge. We’re talking circus-clown, Shaquille O’Neal, Andre the Giant shoes. I feel awkward in these size 24s. I’m stumbling and scuffing them, but I’m not even close to calling it quits. These shoes are staying on. I am trying as hard as ...

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After a complicated stay in the hospital, my patient was finally ready to be discharged. After all he had been through, I was excited to tell him the good news. “You will be leaving this afternoon,” I said, heartened by the smile I saw spreading across his face. He thanked me, and then said something that made me cringe. “Finally! I thought you guys were going to keep sticking me with needles ...

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My email box is an endless source of material for the blog and podcast. As always, details are changed to protect the innocent. Assume genders are swapped about half the time, specialties are changed, and identifying details are obscured. Today’s Q&A provides a great discussion of some things to think about as you approach retirement. The situation discussed is very common among docs and is hardly the only time I’ve ...

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The recent announcement that Berkshire Hathaway, Amazon, and JPMorgan have joined forces to pare down health care costs has sent ripple effects across the health care space. The announcement sent stocks tumbling due to the uncertainty of what influence these companies will have on a deeply complex, unruly and wasteful health care system. Said Berkshire Hathaway chair and CEO Warren Buffett: “The ballooning costs of health care act as a hungry ...

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A few days ago, my Gmail app flashed an email across the screen of my phone.  By mistake, I swiped in the wrong direction, and it opened up an invitation from a medical survey company.  When I had first signed up with this company almost a decade ago, rates were much better (and admittedly, when you are making a resident salary, you don’t have a lot of pride in your ...

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I’m going to keep things broad here: no discussions of index funds, real estate, Roth IRAs or taxable accounts.  This is more of a general discussion on what I feel is important to me, what I invest my money and maybe more important, time into.  There are a few financial topics, but there are many more “time” topics.  On the surface these my seem like individual items, but I assure ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 82-year-old woman is evaluated for a 2-week history of left-sided headaches with pain on chewing, accompanied by achiness in the shoulders and hips. She has no other pertinent personal or family history. She takes no medications. On physical examination, temperature is 38.1 °C (100.6 °F), blood pressure ...

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