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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What is it? Kratom is a powdered herbal supplement derived from the leaves of a tropical evergreen tree that is native to Southeast Asia and is usually taken orally but can also be brewed into teas. It is commonly used by consumers as an alternative medicine to self-treat opioid addiction and chronic pain.  The leaves contain two compounds, mitragynine and 7-a-hydroxymitragyine, which interact with various receptors in the brain. At low doses the ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I recently saw a new patient who came to our practice following a lengthy hospitalization. He is in his 80s with a fairly complex medical history typical of many in this age range. Yet, after carefully sifting through my first introduction to this ...

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I'm not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn't be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world's notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year's Wimbledon finals and was ...

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If someone asked you on day one of medical school, as a fresh-faced first year, to name the essential components of a successful career, what would you have answered? A solid education? Good test scores? Publications? An $800 otoscope? Some are more obvious than others. Who of the enlightened among us would have mentioned a proper work-life balance? How about a strong support system — or the right mentor? Navigating the ...

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Although I would never describe the business of primary care medicine as cutting edge, there are a number of innovations that have come and gone during my short tenure running a medical practice.  The business of medicine is fascinating and leaves much room for personalization and creativity.  I have been lucky to operate at the forefront of practice management and learned quickly how to leverage two bleeding edge philosophies ...

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I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to ...

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There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland. But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 ...

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