Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling. These clients have shared feelings of:

  • shame
  • despair
  • depression
  • loss of self-worth
  • disillusionment
  • confusion
  • hurt
  • defeat
Oddly enough, one of the least common feelings they're able to get in touch with is anger. Maybe it's because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionistic streak. They were, as was I, ...

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Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of ...

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How doctors can cope with stress

by Walter van den Broek, MD, PhD Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients? Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people ...

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by an anonymous physician Recently, Danielle Ofri had a piece in the NEJM about medical report cards. You know, those computer generated reports that tell you how many of your patients have achieved normal blood pressures and normal cholesterols and so on. Dr. Ofri concluded her piece by shoving her most recent report card to the bottom of a stack of more important paper and heading ...

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Treat the patient, not the disease.

Care more particularly for the individual patient than for the especial features of the disease. — William Osler
We enter medical school eager to help the sick and the dying. Over the years this golden objective is transmuted into the base lead of disease-specific diagnostics and therapeutics. Our absorption in the strangeness of the manifestations of a remarkable pathophysiological process may distract us from its impact on ...

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How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue. There's the trademarked "Cinderella Procedure"—a preventive bunion correction that makes feet narrower. The clinic also offers the "Perfect 10! Aesthetic Toe Shortening" that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There's also ...

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Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire. Here's what I wrote a couple of years ago in USA Today: "When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment." Is that still true? Well, yes and no. MedPage Today summarizes ...

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The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years. In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised ...

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Physician/poets such as William Carlos Williams are an honorable tradition in the history of medicine, following in the footsteps of Keats, Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – at least in more recent times –photographers. Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine ...

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The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States. There is no doubt that the United States treats primary care, preventative care and triage much differently than most of the rest of the developed world. The distribution of primary care ...

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