Looking at how incredibly expensive the last few months of life are for anyone in this country, I think most would be quite shocked. In 2014, there were approximately 2.6 million deaths in the U.S. According to a Keiser Permanente study, 2.1 million of those deaths were Medicare related. Medicare’s annual budget is right around $600 billion, and it has been revealed that one-third of that total is spent in ...

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Let’s get one thing straight: You already have kick ass skills as a physician, skills that are valuable outside of clinical care settings. So whenever my physician friends turn to me for advice on making a transition in their career, I have to remind them: It’s not about learning new skills, it’s about translating your existing skill set to new business applications. Think digital health startup CEO, chief medical officer, ...

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Recently, I took a few minutes to fill out a survey on physician burnout.   A slew of studies offer estimates of physician burnout of up to 50 percent.  In my field of primary care, the documentation and regulatory burdens may cause the number to soar even higher. I am rounding out my fifth year in a busy suburban private practice and I am not burned out.  These questions moved me to ...

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The key to staying on time in a busy clinic and to finish the day unscathed is to be in battle mode from the get go. The ten rules outlined below will help you to achieve that goal. 1. Make sure your bladder is empty, and that you are well hydrated. This goes without saying. You don’t want to finish the day with ...

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I wonder what the best thank you any physician has ever received?  I think this one is mine.  This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away.  This amazing thank you has deeply and positively affected me so much ...

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This is a special moment of female liberation, sisterhood, and solidarity. Tens of millions of women have used the #MeToo hashtag to share long-held secrets of sexual harassment and assault. The disgust generated by one extremely slimy Hollywood mogul has triggered a spontaneous worldwide outburst of disgust, righteous anger, and determination to effect social change. The movement is worldwide and includes women from all races, religions, and social classes. It started with ...

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As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course.  It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak. Recently I was at a social event and introducing myself to some ...

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7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel. “He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, ...

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It’s 3 a.m., and I wake with a jolt. My heart is pounding out of my chest. I stumble out of bed to take a beta blocker hoping it’s enough to quiet my heart so I can doze off again. I sleep fitfully the next three hours, experiencing weird dreams and terrifying nightmares. At 6 a.m., I take my Valium. Nauseated, I lie in bed for 30 minutes, so I keep ...

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Dear alternative medicine, Hi, it's HD again. You may remember me from the last time we entered the squared circle, "Endocrinology vs. Naturopathy: Steel Cage Death Match." I had hoped that you might internalize a couple of the lessons I tried to teach you: "Know your assay" and "know your pre-test probability" — but, shocker, it didn't happen. You regrouped, and you've come back more formidable than ...

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