I just heard. A colleague, a man of integrity and warmth, a hard-working physician with ideals, ethics and many valued contributions, has taken his own life. His perspectives may have differed from mine at times, but every interaction was infused with respect. He was a good man. Much has been written about the rate of suicide of physicians. One million Americans lose their doctors to suicide each year. Normally I ...

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My patient The day I met you was early in my second year of internal medicine residency. After much of my internship had been spent on arduous inpatient rotations, I was finally ready to lead my own team of young doctors and students on a high-acuity wards service. Yet, in my continuity clinic, I was still fresh, insecure, and naive. The day I met you, your abdomen was swollen, your eyes ...

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“Polio. I’ve seen polio.” Last night, I was speaking with one of the most experienced pediatricians I’ve ever met, Dr. Jack Burstiner. I’ve known him for 50 years. I would have known him even longer if I had been born earlier. He lived in my neighborhood, two doors down. He was my pediatrician. Jack is almost 90 years old. But he still looks like a pediatrician. He’s got a smile a child ...

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There is a taboo in medicine. It is becoming less prominent, but it still exists. You’re not supposed to talk about money. Not how much something costs a patient, not how much you get paid, not how you invest, and certainly not about the freedom from medicine that financial independence can bring. This first shows up as you are applying to medical school. You don’t want anyone writing a ...

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When I’m working in a hospital setting as a physician, part of my everyday job duties involves going over consent forms with patients. I am of course a medical physician, rather than a surgeon, so generally don’t have to go over them as often. But I do have to take consent regularly for certain interventions including blood transfusions and minor procedures. The process of getting consent is something everybody is ...

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A few weeks ago, I saw a patient with shortness of breath during my Saturday clinic. He had been short of breath for a few weeks, and on a couple of occasions, he had also experienced mild chest pain. He has known aortic stenosis, moderate according to his last echocardiogram two years ago. My brain kicked into autopilot, and I asked: “Have you fainted or passed out recently?” It was a ...

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There’s an ugly undercurrent that sometimes shows up in the emergency department: indeed all over the world of medicine. I’ve seen it in doctors and nurses alike. It’s a meanness, a smallness, a kind of moral judgment that can lead us to make poor medical decisions. Or it can simply make us poorer in spirit. I remember the day I had a young man who was in custody. He was 18, ...

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1. Cancer is not rare.  Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think.   Outside of my work, I can think of 3 people who I know personally that had a childhood cancer.  A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate.   My guess is that you also know someone from church, a coworker’s ...

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How many physicians know how many visits they are approving when referring to a specialist? This was a germane question posed to me today. I first asked this question of myself as a junior faculty member, while busting the residents’ chops over the egregious numbers of referral visits they were approving. You see, as any good resident knows, being proactive in the referral department demonstrates skill in the art of “avoiding ...

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As a mom to two little girls, I understand the lure of online forums. With so many accessible tools — including Google, Instagram, and online support groups like Facebook groups — before a parent brings their child to the doctor, they will inevitably first post their inquiry online. They post a picture: “What’s this rash?” Or they’ll write: “My baby has had a fever of 135-degrees! Do I need to take her ...

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