by Mary McNaughton-Collins, MD, MPH Aging does not have to be all about appointments, pills, tests, treatments and procedures - instead aging should be about celebrating life and rewarding those older individuals who are "living well" by encouraging pursuits outside of the medical realm. The current state of our health care system tends to revolve around the idea that "more is better," however, that is not always true -- especially when caring ...

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In the real world of medicine, "great saves" are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves. I first met Mr. GR in the emergency room. As ...

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The psychosocial needs of patients can feel overwhelming for a doctor. Our rite of passage as medical students, after all, is anatomy, not sociology.  Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in ...

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by Setu Mazumdar, MD Everywhere I go I see unhappy doctors. All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks.  This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades. All of those complaints are legitimate, but one question I always have in ...

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I was sitting next to a resident in the preceptor room yesterday.  He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name ... but not with "Doctor."  (e.g., "Hi, this is John Smith from the Family Health Center.") I occasionally see the residents' patients for urgent visits.  When I ask them who their regular PCP is at the office, ...

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A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department. Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle. Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician ...

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by Greg Smith, MD As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day. If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in
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I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion).  I argued vociferously against it.  However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway.  To our surprise and dismay, it came ...

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Here are the three most useful words for a doctor: "I don’t know." A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes. Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical ...

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I’m a big game theory guy. I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the "players" almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is ...

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