Janelle had overdosed 32 times. Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She ...

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Many health care organizations across the country are taking leaps to address burnout. There are advisory boards formed solely to tackle the issue, access to yoga and meditation, as well as online programs and interactive workshops — just a few examples of efforts aimed at curbing this epidemic. These are steps in the right direction. However, physician burnout is a systemic problem, rooted deep in medicine’s culture, and these steps ...

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So many primary care patients have several multifaceted problems these days, and the more or less unspoken expectation is that we must touch on everything in every visit. I often do the opposite. It’s not that I don’t pack a lot into each visit. I do, but I tend to go deep on one topic, instead of just a few minutes or maybe even moments each on weight, blood sugar, blood ...

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An excerpt from With Mirth and Laughter: Finding Joy in Medicine After Cancer. I am sitting in the waiting area for the one year follow up appointment with my oncologist, Dr. Anne Blaes. Using the handy phone app, “How Long Ago,” I see it’s been eleven months, nine days, five ...

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The room is half-lit from the sunset. Crowding around the bed, in almost saint-like postures, is the family of our patient who is in her last moments of life. I do my best to console the family, a light touch on the shoulder, and honest stare. Then, there’s the inevitable moment, the palliative extubation. Our patient, gasping for air, head turned to her side, the room in a quiet somber. The moment ...

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When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin. I was due ...

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Health care is big business, with medical practices vying for contracts, hospitals undergoing facelifts in order to cater to patient experiences, and insurance companies making deals with pharmacies.  Some of these arrangements are negotiated in the name of reducing health care spending, but there has to be some skepticism when for-profit entities are implicated.  Physician salaries aren’t exactly growing with inflation—some fields have had massive cuts in spending over the ...

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In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment ...

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In the service industry — which as physicians, we certainly are a part of — a popular saying is that the customer always comes first. The implication is that in order to thrive in an industry, you have to cater to the customers/patients as it is they who will ultimately decide where they take their business. In medical school, the emphasis on prioritizing the patient was evident, culminating in the Hippocratic Oath ...

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After spending much of the first 40 years of my life poring over textbooks and medical journals, I decided to start reading literary fiction. At the time, I had no ulterior motive — only a vague sense that I had been missing something important, a metaphoric vitamin without which my development would not be complete. I certainly did not expect that the great novels would make me a better doctor. ...

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