Closing a medical practice to new patients is like cutting off the very top of a tree. It’s the beginning of the end. The top of the tree, the crown, is where the newest leaves are. It’s also the part that continues growing ever upward, at least until it reaches it’s maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on ...

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It’s amazing what you can learn from the stranger sitting next to you on a flight. As I wait for my neighbor to grab her seat next to me, I secretly hope she embodies the qualities I hope for in a fellow passenger -- keeping to herself and not requiring in-flight medical assistance. I make eye contact with a young woman who gives me the nod that she has the middle ...

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Today I met a man who wanted to interview me before transferring his records. He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. ...

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asco-logo I like to consider myself an “evolved” clinician -- one who believes in the patient’s voice, personally invested in shared decision-making, always ready to support my patient’s decisions, as long as I know it’s informed by the best data I have available, even when it is not the course I would want them to make. Most of ...

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As a goal-oriented individual, I pack my days with appointments, deadlines, and to-do lists. Unfortunately, the time I spend getting from one task to the next gets lost in my focus on end results -- a common blindness of Westerners who measure success or achievement by results and not by how one “plays the game.” As parents, we teach our children it’s not whether you win or lose, but how ...

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Imposter syndrome (n.): Term coined in 1970 by psychologists and researchers to informally describe people who are unable to internalize their accomplishments despite external evidence of their competence. When I was in medical school, I remember walking outside the library and trying not to glance inside to see how many of my classmates appeared to be meticulously studying for final exams. I remember trying to ignore their off-hand, and occasionally self-congratulating, ...

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You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is ...

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Mnemonics can be incredibly cool. When I was in medical school, there was just too much stuff to remember and memory aids were so very helpful. Most specifically I refer to the vile and inappropriate one that helped me remember the cranial nerves which I remember to this day and will not share in print. In ancient times orators used memory palaces to memorize long speeches or poems, associating words with ...

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Dear American Board of Pediatrics: On December 17 2015, at 3:01 in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics certification. I thought I should write this letter, hopefully preempting any more threatening emails warning me that I must pay up or lose my certification. This was not mere oversight on my part. This was purposeful. The reason I am no longer ABP ...

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Within the last several weeks, I’ve had two plumbing issues that have caused me to reflect on the honorability of various professions and the way in which people go about earning an honest day’s crust. Let me take you back to the beginning of the story. I was actually working nights a couple of months ago when I noticed, just before I was about to leave for the hospital, that my ...

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