For whatever reason, being 35,000 feet in the air makes me reflective. During one flight, I had a flurry of thoughts, and the reason I decided to get into this whole mess of direct primary care spilled out of me. I want to share it here because if you don't know why -- or you can't convey why -- you're doing something, what's the point in doing it? In line with ...

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Happiness doesn’t always come easily. Some people seem naturally happy, like they inherited the right gene or were born into the right circumstances. Many other people struggle to find happiness. Perhaps even more people hope to become happier than they already are. But what kind of plan should people follow if they are hoping to become happier? Or will any kind of plan merely make it harder to thrive?

It ...

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As I enter the exam room, I hear, “Don’t get old honey!” As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!”  I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.”  Usually, my level is offense is ...

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Physicians across all levels of training are familiar with the widely recognized truth that our medical system is broken. This damage is evidenced by a paradox; perhaps it will become the great paradox of our time – physicians who were driven to a profession by a desire to help others are now the same doctors who secretly hope they don’t have to help you. It is 9 p.m. on a fairly ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman undergoes perioperative evaluation. She has osteoarthritis of the right hip since sustaining injuries in a motor vehicle accident 15 years ago and is scheduled for elective hip arthroplasty in the next few months. Medical history is otherwise notable for type 2 diabetes mellitus. She ...

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I recently started watching the HBO series Chernobyl, chronicling the events surrounding the 1986 disaster. For anyone who hasn’t seen it yet—I’d highly recommend this excellent production (It’s already deservedly won multiple awards). The great thing about TV like this, which documents real-life events (and I’d put another HBO series John Adams in the same category), is that they can really bring complex consequential events to the mass audience, in ...

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You’re at the top of your game. And you are perhaps thinking that this is not how you envisioned life at this stage in your career. Many successful physicians are frustrated that they can’t find the time or energy to be present with their family and friends. They haven’t even thought about activities just for fun and creativity. Taking a vacation seems impossible without the practice coming to a screeching halt. You ...

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The first day I sought counseling, I felt like I was committing a crime. Our afternoon anatomy lecture had just ended, and the entirety of our first-year medical class—clad in hunter green scrubs and reciting the intrinsic muscles of the back—paraded in what looked like a single-file line to our cafeteria. "Act natural," I thought. "Don't let anyone find out what you're up to." My friends veered right to enter the cafeteria as ...

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Brain surgery is getting smarter. The journal Nature Medicine recently published a study that found a new imaging technique that allows pathologists to diagnose brain tumors faster and more accurately than ever before. The study focused on Invenio Imaging technology’s use of artificial intelligence (AI) in making accurate diagnoses. So, will computers replace doctors? That’s unlikely. Treating the human brain requires a human approach. But AI is ...

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Gun violence has become a public health epidemic. Despite countless deaths in mass shootings over the last two decades, the Dickey Amendment—a provision inserted into the 1996 spending bill which blocked federal funding for research on gun violence—remains on the books. While every politician, media pundit, and policy expert “know” the solution, the answers are not that simple. In reality, the factors which have fueled the rise in gun violence across ...

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One of the most important things to understand about heart health is that a woman’s needs change over time. Risk factors for heart disease like high blood pressure and high cholesterol can become more important as a woman ages.  Hypertension and high cholesterol are not things we may feel. This is why hypertension is called the silent killer. Even women who have always maintained normal cholesterol and blood pressure levels could ...

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Trust has always been the foundation of any relationship between a patient and those of us in health care. Clinicians enter patient encounters with the presumption they will be trusted, based on their knowledge and good intentions. But medicine is changing, and today patient-doctor relationships are buffeted by a complex labyrinth of a rapidly evolving health care landscape and an exploding information environment. As physicians, we must adapt to this changing ...

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With the advent of countless resources and study aids over the years to help medical students prepare for the USMLE Step 1 exam, ranging from the venerable First Aid review book and Anki flashcard decks, to online tools such as UWorld, Pathoma, SketchyMicro, Firecracker, Amboss, and countless more, the entire process of studying for Step 1 has become an arms race. At the same time, Step 1 scores have established ...

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Protecting your lifestyle starts with protecting your income. Disability insurance provides a solid foundation for your financial future by providing you income when you’re unable to work due to an illness or injury. When most people hear the word “disability,” they immediately think of accidents. But the reality is that 90 percent of disabilities are actually caused by illnesses. Disability insurance is more complex than other types of insurance. We recommend ...

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In December of 2011, I made a career move that changed my life. My life as a surgeon was getting stale. Doing the same old thing for two decades was getting old, and I was looking for something to breathe new life into my surgical practice. I decided to look into doing a short term medical mission. I thought it would be fun and rewarding to travel to a new place ...

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Spiraling costs, poor quality outcomes, and inequities in access to care are driving significant and long overdue changes to the way health care is administered and managed in the United States. And while the U.S. spends more on health care per person than other wealthy countries, its health outcomes are no better than those in other developed countries. In fact, it performs worse in several health metrics, including life expectancy, infant ...

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We sat in the driveway, my business partner and I, each peering out our opposite windows, each wrapped in the disappointing sense that we had failed one another while the uncaring car simply idled in the background.  “We agreed on this,” my partner said, without turning her face toward me.  “No, you told me how we were going to do this, and I said nothing” was my response as I ...

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In honor of Black History Month, I wrote this article to say thank you to all the wonderful black doctors breaking boundaries and exploring careers that would have been unattainable to black people in late 1800 and even early 1900 America. To all the black doctors, your representation in medicine matters a lot. I am a third-year black female medical student, and I recently completed my pediatrics rotation. A few weeks ...

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Legislators have found a new way to insert themselves into the physician-patient relationship. In October and November 2019, news stories regarding a parental dispute over the treatment of a transgender child prompted legislators in Texas, Kentucky, and Georgia to announce plans to introduce bills that would prohibit medical and surgical treatment of transgender children under age 18. Since then, Read more...

Let's talk about the doctor who is excessively defensive. I divide this kind of communication blocker into two varieties: physician personality and physician mode of practice. The physician with a defensive personality is one who interprets questions from parents as questioning of her medical judgment. Unlike the supremely egotistical doctor, who is often sufficiently secure in her image of herself that she is magnanimous toward parents who ask questions, the overly ...

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