One of the biggest changes to health care over the last 20 years has been the corporatization of medicine, from small independent physician practices, to large corporations that now run the show. Medicine has gone from good old Dr. Johnson’s office around the corner, to a world of boardrooms, megamergers and takeovers. This has enormous downstream effects -- not least to the way physicians practice medicine and their ...

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It seems now as if every day and every month is associated with a "national day" or an "awareness month."  Some such as "national taco day" may be less important than others, well depending on one's priorities.  Although many illnesses now also have a dedicated day or month, many of these diseases will go unnoticed.  They will rarely be discussed -- that is until a celebrity or someone in the ...

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I’m sitting on a cross-country flight to California with utmost respect for the professionalism of the crew, especially considering my life will be in their hands for the next 6 hours. Despite understanding the physics, I am still amazed by flight, and even more so by the coordination required to manage the logistics of shuttling so many people and their luggage around the world. As health care leaders apply a business ...

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A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties are divided up. If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the ...

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“Does my insurance cover this?” I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I -- a gastroenterologist -- do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues. Of course, patients assume that we physicians have an expansive ...

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When writing medical notes, some clinicians include an appreciation of their patient's personality and disposition in their opening line (the "chief complaint"), or when they're wrapping up (in the "assessment and plan"), or in both locations. You know — it goes like this: "CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …" or: "A/P:  To summarize, Mr. Jones is a delightful 89-year-old man presenting with …" or: "CC:  This lovely 74-year-old retired school teacher was in her usual state of health ...

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Jeanette Brown had lost twenty pounds, and she was worried. “I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine: A normal weight, diet controlled diabetic for many years, her glycosylated hemoglobin had jumped from 6.9 to 9.3 in three months while losing that much weight. That is exactly what happened to my mother some years ...

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She was a middle-aged female who was life-flighted from an outlying facility to the tertiary care hospital in which I worked. As she quickly rolled out of the elevator, I ran toward her and saw her blood pressure was tanking with her mentation fluctuating. My hair mindlessly placed in a ponytail, my blue scrubs wrinkled, and my nerves a jumbled mess, EMS briefly gave me an account of her history: ...

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We have all received many gifts throughout our lifetime. Most are long gone and forgotten, but a few gifts stand out as favorites. As kids, we are given so many toys that we don’t even remember most of them. As we get older, practical gifts like ties and socks are given. Sometimes people don’t know what to give us, so we get gifts we don’t even want or need. There ...

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I delight in learning my patients' stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary mystery to be solved, my Sherlock Holmes moment. This is why, if somebody asks me, I will tell them that doctoring is the best job in the world. The opportunity to connect ...

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