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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“Doctor, how would you like your schedule template?” As a hematology/oncology physician in a non-profit hospital group, I am reimbursed by wRVU. This is the standard mechanism of reimbursement for large multispecialty groups and academic centers. In this scenario, the more wRVUs you make, the more you get paid. However, there are only so many hours in the day. One of the first decisions each doctor makes when joining a group ...

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Here’s the typical story we come across every day: Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: He eliminated X, Y, Z and added more A, B, and C. He’s now lost 30 pounds, and he feels fantastic. His numbers are also perfect: His HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range. Todd was overweight and had ...

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Phnom Penh is changing at an incalculable rate. It is evolving so quickly that even from my last visit four years ago, I barely recognize the streets I once shuffled my well-worn sandals through. Now, the streets of my old neighborhood are proudly adorned with a new facade of artistic, stylish restaurants and a collection of boutique coffee shops. Bigger buildings and prime real estate positions are now occupied by ...

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A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today's standards I would be considered a “good old country orthopedist.” Thirty years ago, I moved to a small community to ...

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Let me post a question that neither I nor readers can answer: How much of what I do during the course of a day directly benefits patients? Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care. I would ...

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So stated one of our children in their autobiography assignment for school.  I kept reading, curious what would come next. “My dad usually stays home and cleans up, and takes care of the pets.” I thought for a moment.  “That’s very good, honey, but do you think you could write something else about Dad?” I suggested.  “He does other stuff too, add some more nice things.” “OK, how about … ‘And he takes ...

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Health care in America and the practice of medicine has undergone a sea change over the last couple of decades. It used to be about Dr. Johnson’s office around the corner that would serve you and your whole family. Nowadays, it’s about mega-specialty groups and large health care conglomerates. It’s about mergers and hostile corporate takeovers. Statistics now suggest that over 50 percent of physicians are employed rather than ...

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