There's currently an image in heavy circulation making its way around the internet of a hospital patient's chest tattooed with the words "Do **not** resuscitate," accompanied by what is assumed to be the man's signature. This 70-year-old patient arrived at an emergency department unconscious with elevated blood alcohol levels. He did not have any form of identification on him, and his health care providers did not have an identifiable means ...

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Physicians are no strangers to death. We are baptized into medicine with cadavers as first-year medical students. We learn to break bad news. We lose patients, some that are expected and some we never see coming. Through it all, we maintain a distance, an emotional reserve that enables us to shoulder these losses but still see the next patient with the full attention they deserve. But every now and then ...

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The most common dividing lines in the national discourse on health care reform simply miss the mark. If one looks beyond the partisan posturing, each side has valid points, but also glaring weaknesses. We may need to work together to get health care right. I was recently invited to a political gathering to discuss health care reform. The room quickly divided along traditional lines. From left of the political spectrum, there were ...

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My new patient was having trouble breathing and had lost his ability to swallow; despite this, he had been too proud to call either friends or family for help. He had lost thirty pounds and his clothes hung loosely. His belt was far too long. The day I met him, I thought, “This man could walk through a harp.” People had tried. Over the previous months, his worried family members had ...

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That’s right folks, I am talking about two types of money saving maneuvers:

  • Save Money #1: spending as little as possible when making purchases through price competitions, coupons and rebates.
  • Save Money #2: putting money you don’t spend into savings and investment accounts for your future.
Save money on purchases ‘Tis the season for giving, but ’tis also the season for buying.  Make sure you are doing everything you can to save ...

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178 measures. This is what we're up to -- the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions. Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive? That's a lot of questions all at once, and I'm not sure we're ...

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The committee that plans and oversees medical care for the county of Hertfordshire, England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least eight weeks, they will not be allowed to undergo elective surgery. Patients with a body mass index (BMI) greater than 40 must lose 15 percent of their weight within nine months, and patients with a BMI over 30 ...

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The commentary below is meant to invoke meaningful discourse rather than incite an unpleasant argument. Less than a year ago, I heard Ben Stiller doling out kudos to his heroic doctor who diagnosed him with early-stage prostate cancer by using a simple, widespread screen. What was interesting was that Stiller was actually underage. What I mean is that the star was not of age to be screened, according to current prostate cancer ...

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A recent post about a physician using her maiden name professionally generated major controversy on a physicians’ group. Hundreds of comments later, it became evident that female physicians who chose to use their maiden names are subjected to negative judgment. I am a physician married to a supportive man who understands my choice to keep my last name. I am not unique in my circle. Most of my female physician friends ...

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According to published reports, over 50 percent of doctors are burned out. The reason? They are overwhelmed by payment and quality rules as well as poor information technology. It’s no secret that physicians spend long hours seeing patients. But as financial pressures have mounted within hospitals, doctors are forced to perform more administrative tasks. In fact, administrative tasks account for nearly ...

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I owe a lot to Robert Kiyosaki. His book, Rich Dad Poor Dad, actually helped start me on my path to financial freedom, and his other writings have all taught me very valuable lessons. While I don’t agree with everything, he says in every book, one thing that really cemented the idea of passive income in my mind was the concept of the “cash flow quadrant.” This concept is so important and ...

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There is a movement afoot. I can feel it. I can see it. Women in medicine are no longer going to tolerate the subtle and not so subtle discrimination that has stymied their career growth. They are not going to be complacent while their male colleagues are paid higher salaries, offered speaking engagements and research opportunities and promoted at a greater rate. Women in medicine are pulling together in an ...

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I often say that electronic health records (EHRs) is like Skynet in the Terminator. I expect to turn around from my screen someday, and Arnold will lift me by my throat saying, “You haff not been doing yuh meaningful use.” We practice in a time when EHR confounds us by freezing, crashing and chaining us continuously to our work, as we spend evenings and weekends on documentation. ...

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About a year ago, I did away with TV. It was an overwhelming expense with little personal utilization. I thought to myself while struggling with the decision to cut the cable, “What will I be missing?” I may no longer be "Keeping up with the Kardashians," but I do keep a regular eye on my iPhone news feed. It is an addiction many people share. That itch to grab our ...

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Recently, there was a fascinating article in the Wall Street Journal regarding robot-assisted surgery. It reported the results of two articles published in JAMA that demonstrated that robotic-assisted surgery cost more and took longer without achieving superior results to laparoscopic surgery on average. With this, my LinkedIn account lit up. Here are several of the comments that came through: “I've come to assume that robotic surgery is better ...

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I am an Olympian. I am a retired All-American student-athlete.  I am a resident.  I am burned out. Let me be clear: I love medicine and the opportunity to have privileged relationships with patients and their families.  I thrive on the fast-paced environment, growing to-do lists, and the chance to work in a field with endless learning.  I love working in team environments to provide optimal care for patients and their ...

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In order to safely plan for a successful retirement, it’s imperative to have a general idea of what your spending needs will be when retired. We cannot calculate whether or not our anticipated withdrawal rate would be considered safe (in the range of 3% to 4%) without knowing the size of the annual withdrawal. That number can be difficult to pin down, as there are many variables. It can be informative ...

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Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die.   We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza ...

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When interviewing for my book, I asked about insurance, but the topic came up even when I didn't specifically ask about it. It was never positive in relation to practice. A doctor said, "I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it."Another one said, "This completely changes the ...

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It was nearing the end of my day at the mobile health clinic where I work as a nurse practitioner, providing free, comprehensive primary care to uninsured patients in central Florida. Clinic was officially over, and we were no longer taking patients; I was signing notes and finishing up some teaching points with a PA student when a woman walked up and asked me if she could “talk to me ...

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