This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy.  People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity. Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is ...

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I have a dream job. I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday.  I’m off Friday through Monday, and I don’t take any call.  I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety. It wasn’t always this way.  Like all new doctors recently out ...

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I’ve noticed as I get older, life seems to travel full circle no matter your path or destination.  I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago.  “Don’t do that, you’ll fall and hurt yourself."  Or, "Try it this way and the process will be much easier.”  There is that brief moment of acknowledgment often followed by scraped ...

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“Don’t forget to bring that stool card back in, OK?” As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon.  I’d hate to have colon cancer.” At this point, I’d hate for him to have a positive occult blood card.  I could really care less about colon cancer.  Colon cancer isn’t going ...

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Up to a third of resident physicians suffer from clinical depression or its symptoms. This was the finding of a large review of 54 studies involving 17,560 resident physicians, published in JAMA recently. In some of the studies reviewed, up to 40 percent of resident physicians reported depressive symptoms. The study found these physicians were 4.5 times more likely to suffer from depressive symptoms following beginning residency training. ...

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It is important that I make two disclaimers:

  • Disclaimer 1: I am a human being. I feel we run the risk of idolizing people through social media and I want to come out and say that I am really no different than any other person -- flaws and all.
  • Disclaimer 2: I am well aware that your amazing blog aims to promote the stories, journeys and challenges of women in EM … ...

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After months of negotiations, the Conference of Parties 21 (COP21) adopted a historic and unprecedented climate change agreement in Paris recently. The Paris Agreement reflects nearly universal recognition among parties that climate change demands an urgent, coordinated response. This agreement includes cutting greenhouse gas emissions to curtail the average global temperature rise to “well below 2ºC above pre-industrial levels and to pursue efforts to limit the temperature increase ...

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What do you do when you love your job, but it’s killing you? That’s an easy question if it’s asked by someone else.  It’s a hard question when you’re asking it of yourself.  As a physician, I give advice to people all the time -- other people.  If you have diabetes, control your diet.  If you are obese, then lose weight and exercise.  If you have COPD, then you better not ...

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I thought about you, the patient that I’m about to perform surgery on, all night last night and because I doubted myself, I took clonazepam to calm the anxiety so I could sleep.  Today I’ve taken 10 mg of propranolol and some Kava, a natural supplement known to decrease anxiety. As I start the surgery, the propranolol coursing through my veins blocking the sympathetic nervous system, I fear it will come.  ...

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"Do you have a family history of sudden death?" In medical school, I learned to ask my patients this standard prompt during sports physicals, in search of possible hypertrophic cardiomyopathy. Their answers often surprised me. Many of my patients do have relatives who suffered a "sudden, unexplained death," often the result of a murder or suicide. Which feels, in a way, utterly unexplainable. The impact of violence, including deliberate self-harm, is overwhelming: According ...

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