Take 100 patients who are candidates for colorectal screening. We know that a group of them will try to avoid the procedure or postpone it for as long as possible. Evidence of this, for example, would be rescheduling appointments multiple times to later dates. We also know that among this 100 is another group of people who need a colonoscopy more than others. A family history of cancerous polyps is a ...

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One of the least motivating requests I received routinely as a new intern was something like, “… and can we make sure this is a discharge before noon?” I recall a particularly eager nursing manager surveying the resident teams on her unit to gauge our interest in arriving even earlier each morning (5 a.m., perhaps?) in order to prepare potential discharges before pre-rounding. We shared a nice laugh.


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A physician health program, PHP, is a state agency that is responsible for advocating, treatment referral and physician monitoring, residents and medical students who have substance abuse disorders, psychiatric disorders and/ or boundary issues. There are two ways of becoming a part of these programs, self-referral or be reported. Currently, 47 states have a PHP, and the issue is that there is no set guideline and several variables in the ...

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Your medical training has failed you. When it comes to leadership, acting as the supreme commander — large and in charge — is not solving your problem. You are racing from patient to patient, running as fast as you can to keep up. You see your income falling while your workload increases and the joy you used to derive in helping people to live healthier lives evaporating. How much longer can ...

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It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama. If you haven’t worked there, or haven’t for a ...

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My brother and I are both physicians. He is a pediatrician; I am a geriatrician and palliative medicine doctor. We are both getting older. My brother has been a practicing pediatrician for almost 50 years. He had a remarkably successful solo practice in the city where he lived. He recently retired but continued to work at a free clinic several days a month. When it became time for him to renew ...

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My 20-year medical school reunion was a time to reflect: Have we aged more gracefully than medicine? The Class of 1999 carried books and wore pagers while scrambling to gather paper charts for rounds. Residency did not prepare us for the explosion of managed care, EHRs, health systems, and allied health providers. What do I wish I knew then? The hardest part of medicine isn’t becoming ...

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In our office, sometimes our secretaries listen to background music. A few days ago, while walking through the office, I heard an iconic song, written and performed by a songwriting legend. Even someone like me, who was never deep into the music scene, automatically recognized the song. I asked our receptionist, a young lady in her 20s, if she knew the song that was playing. She didn’t. I identified the ...

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"The hospital room was as cold as dead skin, the hallway crowded with lost souls and reeking of illness." ― Raquel Cepeda, "Bird of Paradise: How I Became Latina" Once upon a time, I met a young lady who wanted to be a doctor. I could see the naked determination and resolve in her eyes. Her older sister, who was a friend, asked her to talk to me about her dream. I asked ...

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What really makes a person complete? What do we want in our lives, and what is it like to become our best, most fulfilled selves? In the 1960s, psychologist Abraham Maslow tried to answer this question. This eventually led to his well-known hierarchy of needs. You might be familiar with the pyramid. The premise of the theory is that once we fulfill our basic needs ...

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