The fertility clinic waiting room is a space where many people will find themselves at some point in their lives. In spite of cheery music, shared success stories, infertility awareness weeks, and positive media campaigns, this can be a challenging and sensitive time. About one in six Canadians experience fertility problems — these range from difficulties getting pregnant to difficulties staying pregnant and experiencing pregnancy loss. As fertility specialists, we know that ...

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The front-desk clerk, Ruth, comes to me and says Rose Henderson wants a cab voucher signed — which guaranteed payment. Rose could not be made to understand, Ruth tells me, that we are not permitted to sign vouchers when the person, the client, comes to our offices solely for the purpose of picking up cash ... which is Rose's purpose. We are Rose's payee, which means we handle her money. I ...

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I recently wrote about my new type 1 diabetes diagnosis, the quest for affordable meds and supplies, and the subsequent financial savings found through transparent pricing outside of my insurance plan. I summarized that health care "coverage" is very expensive, whereas medical services may be found much more affordably. My next step was to establish an ongoing primary care physician relationship. I contacted one of the large medical ...

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Do you think I went too far in my last blog post, calling out some journalists as “pontificating parasites” who love nothing more than to slam physicians and blame us for the cost of health care? If you do, then you must not have read Elisabeth Rosenthal’s latest salvo in the Feb. 16 New York Times, where she says physicians are in “a three-way competition for ...

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Ever since the publication of the infamous 2016 BMJ opinion piece claiming medical error should be considered the third leading cause of death in the U.S., the debate on the true incidence of deaths caused by medical error has been raging. Many, including me, felt the estimate of 251,000 deaths per year from medical error was grossly inflated. For example, the paper extrapolated the number of deaths from ...

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In my very first job as a doctor — working in a London hospital in the 1980s. I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream. The neighborhood surrounding the hospital had once been the worst slum in London. And it didn't take ...

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The truth is: While physicians are not allowed to discriminate against their patients, patients are allowed to discriminate against their physicians. This is particularly true in the private sector, fueled by online physician profiles permitting patients to choose provider characteristics ranging from those as benign as Ivy League training background to those as problematic as racial ethnicity. In this setting, the U.S.’s free-market economy reigns supreme — freedom of choice is ...

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Recently I made a self-deprecating joke among friends, when one of them said, “that’s so Jewish,” to which another quipped, “What do you expect? It’s in the genes.” The idea of a Jewish gene is not necessarily new, but it has become more popular and more concerning in recent years.  For example, today, direct-to-consumer genetic testing companies, like 23andMe and Ancestry.com, identify people with certain genetic markers as being a percentage Jewish, ...

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I am in the operating room working with an attending anesthesiologist I have known for years. "Tell me," I ask, "Do you and your colleagues talk about the difference between Des and Sevo?" He looks at me without responding. "You see," I continue, "There was a story on the radio about a hospital that has gotten rid of Desflurane because of the environmental impact. It is ...

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I am a primary care pediatrician. I am one of the thousands who serve our youngest and most vulnerable each day. Any pediatrician will tell you we are the underdogs of the medical hierarchy. But for me, it’s still the best calling on Earth. When I walk into an exam room, you will see my eyes lit up, my eyes bright, a happy lilt to my voice. You will sense the ...

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Our local newspaper recently ran an article on the top of its front page, stating that our monopoly health system is now “expanding health care cost discounts.”  The article was actually a press release - free advertising on the front page. As a primary care physician who refers patients to this health system, I wanted to know what these discounts really meant. So, I asked the newspaper in an editorial, “what ...

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Recently, my mother waited for over an hour for what turned out to be a 5-minute visit with her primary care doctor. Her doctor seemed rushed and stressed, her questions perfunctory, the management plan hurried. And then she was gone. “It’s like she didn’t even know I was there,” my mom relayed to me. This is a physician who is thoughtful, intelligent, and kind, with excellent clinical instincts. After this visit, ...

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Recently we had a patient admitted for a diagnosis that did not really fit his problem representation. The diagnosis was a convenient one, and easily treated. He initially responded to treatment, and we discharged him. The diagnosis assumption nagged at me, but I did not push forward with a test that my mind wanted. A week later he returned (the dreaded readmission), with the same symptoms. The admitting resident expanded the ...

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Physicians are excellent at floccinaucinihilipilification, which is seeing something as unimportant or worthless.  We engage in floccinaucinihilipilification every time we see a patient. We listen to their story and symptoms, and quickly filter, accept, or discard information until we arrive at our presumed diagnosis. The 18-second rule In 1984, Beckman and Frankel wrote in the Annals of Internal Medicine that the average time it takes a physician to interrupt ...

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I am a critical care RN, and I violated my patients’ rights. For decades, every day that I worked in the emergency department or the intensive care unit, I violated my patients’ federally protected rights to participate in their plan of care. I didn’t mean to, or want to, but my tasks to maintain their life took priority over the obstacles to hearing them when they could not speak. Almost every day ...

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Mr. O has a drinking problem. More specifically, Mr. O drinks far too much and far too often, and for reasons that can't be addressed with the tool he's chosen. I met him at what could be called the low point of his life, except I know better than to hope things will look up. On a night I covered the intensive care unit, this particular man ascended from the coma ...

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I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia.  He cut his head in a fall, suffering the ravages of gravity as so many do every day, every night. He was Caucasian.  His full-time care-giver was African-American.  That young man was the only person who could calm the angry, profane mood swings of his increasingly difficult, neurologically ...

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On my final day of work before beginning my self-imposed  burnout sabbatical, a colleague asked, "Why don't you just get on medication?" I remember thinking, "What am I medicating?  I feel nothing." I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted.  But mostly, I was numb. But in reality, I have always self-medicated - with work.  As a professional ballet dancer turned doctor, my life has ...

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The chances that you or someone you love will be diagnosed with dementia are shockingly high. By age 65, your chances are already at 9 percent. Make it to age 85, and the chances go up to 33 percent. Of course, if you’re diagnosed with dementia, it will be a struggle for you to think clearly about your diagnosis. So, today, while all of your faculties are still intact, I’d ...

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Calling. I am awakened by the loud, screeching sound of my pager. I feel my heart race. I look at the clock. It is 3:07 a.m. It’s cold in the room. I am shivering. I stand up quickly, instinctively. I feel the soreness of my feet for a brief moment, but push that thought aside and look quickly at my pager. It reads, “room 2309, death pronouncement”. My heart sinks. She is mine—my ...

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