I have a theory. There is a simple thing hospitalists can do that can enhance relationships with our patients, and even, I bet, improve patient satisfaction scores. The catch is it is not something you can do for yourself; you can only “pay it forward” for somebody else. We know patients who trust their physicians are more likely to follow recommendations, and that trust and confidence in physicians probably ...

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Death and dying — it is one of the first topics I was taught about in medical school.  I was fortunate to attend a medical school that only made us spend half our time falling asleep in lectures.  The other half we were in small group sessions, working our way through real patient scenarios, trying to learn to think like a physician. As part of our first-year curriculum we had to spend time doing ...

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The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years ("Informed Consent for Babies: When Experts Disagree," "Informed Consent in Infant Research: Ethical Problems Remain," "Informed Consent in Comparative Effectiveness Research," and "The Erosion of Informed ...

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Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with. The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.” With more than fifty calls in my inbox and no memory of what the issue was with Mr. Brown’s current blood pressure, I replied: ...

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Earlier this year, I wrote a piece about friends and colleagues of mine who have left HIV clinical practice. Something about it touched a nerve. Admittedly, it was kind of a downer — but it might have been slightly misinterpreted. A lot of the problems my friends cited could have easily applied to almost any area of clinical practice; these challenges were by no means limited to HIV care. They mentioned the ...

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Vanguard, Fidelity, and Schwab have been engaging in a fierce competition to claim the mantle as the leading provider of low-cost index funds. As a result, each has aggressively lowered their fees for their index fund offerings over the past few years and advertised their low-cost offerings to investors. After the latest round of fee reductions in mid-2017, I wrote a post speculating whether it was inevitable that Vanguard, Fidelity, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations. On physical examination, vital signs are normal. She has shotty cervical ...

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Writing in Annals of Family Medicine a few years ago, Chicago obstetrician Benjamin P. Brown vividly described his mentor’s interaction with a patient who had just emigrated from Mexico and had no family support. “When he asked earnestly how she was doing, her hard-won defenses seemed to crumple, and all of a sudden she was sitting on the exam table, sobbing,” Brown wrote. “I watched, rapt, as Dr. Gonzales -- ...

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The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit rules. Added to that are multiple electronic medical records that need to be implemented, vary from one hospital to another, and often do not “talk” to one another. Thus, it ...

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“I love what I do. I hate what I have to do.” It's a quote that doctors attribute to their profession behind closed doors. As patients, we are so overwhelmed with our own problems. We fail to notice that our doctor may be battling her own problems with a complicated system. But what do we care? Our meeting with the doctor is a paid transaction. We are owed our money's due. Empathy ...

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What makes a good doctor or, for that matter, a great one? Most patients want physicians who are excellent clinicians and diagnosticians. But we also want doctors who are caring, empathetic and maybe even telepathic — doctors who seem to know intuitively what we need without any awkward discussion of sensitive issues. After all, patients may not want or know how to talk about substance abuse, domestic violence, sexually transmitted disease ...

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If money is the root of all evil, what does that make debt? Evil’s ugly big brother. A report by the Association of American Medical Colleges (AAMC) revealed that over 86 percent of medical graduates carry an educational debt principal of over $160,000, with a significant number of graduates reporting debt totaling over $350,000. In addition to massive student debt, personal financial challenges include the loss of nearly a decade of ...

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Three years ago, I left the only path I had ever known to pursue uncertainty on the other side of the world. But let me back up. In July of 2011, five years into my career as an academic hospitalist, the residency work hours changed. Although the intent was obviously to benefit the well-being of the residents and the safety of patients, it took a tremendous toll on attending physicians ...

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The trouble began when I needed to open the electronic health record (EHR) system for the tenth time that day. EHRs have significantly changed the way we practice medicine. They have completely eliminated the need for storage and transport of paper charts, reduced prescription errors secondary to illegible handwritings of physicians and provided an excellent platform to maximize billing for services rendered. However, in terms of creating a smooth workflow ...

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Mr. Smith was a sixty-eight-year-old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain. “With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when it started, how long it lasted, how intense it was if it was still there. His electrocardiogram hadn’t shown ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes ...

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asco-logo In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to ...

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American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue. So what happens when uninsured patients make it to the doctor’s office ...

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The most common hurdle that doctors have is overspending. The notion that good income guarantees great buying power not only delays building financial worth but also confines doctors to lengthier careers than needed.  The solution, in a nutshell, is to make sure that we make prudent financial and career choices to complement our financial velocity. Easy, right? The reality is not so simple.  Psychology is fascinating. Human behavior can function, at ...

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With the transition to residency, I’ve spent a lot of time thinking about next steps in my career. I even did a self-reflection exercise for a class in which I listed out professional decisions that will come up in the next few years (including choices like fellowship selection, type of practice setting, whether to pursue management roles, and more). I then rated the different options on a set of six ...

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