Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day that physician checked a urine drug screen and a prescription monitoring program (PMP) report, only to find that she was obtaining various opioids from several providers. The physician cut her ...

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First of all, many osteopathic medical schools are located in underserved areas — or as underserved as possible while still having enough of a medical community to make training possible. My school, LMU-DCOM is located in the middle of Appalachia, for example. Osteopathic medical schools generally encourage students to specialize in primary care, at least as much as they can, considering that our health care ...

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The medicine I practiced between 1974 to 1992 is gone. Evidence is the coin of the realm in the courts of modern medicine. The rule “first, do no harm” demands a corollary — be paranoid. We receive extensive training and licensure to “touch” patients. Any person who is not a physician who cuts into another person commits a very serious crime. The same is true for merely talking with a person, ...

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I am both relieved and nervous because they say that the first year is the worst, but now I have the overarching cloud of doom following me around during second year: Step 1. Now that I’m home, I constantly am wondering how I made it this far — in disbelief that I passed all my courses pretty well. I constantly ask myself if exams were too easy and if I’m just ...

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Some days, work frustrates me. Yes, we all have our frustrations. Maybe the traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short of help at work. But my frustration has to do with not being able to properly care for my patients. This frustration lies in ...

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Physician financial literacy is dismal. In the past, many physicians got their first introduction to finance from insurance salesman or financial advisors who give presentations over a free steak dinner. My medical school’s attempt at teaching us personal finance was to have a financial advisory firm give a half-day lecture about student loan management, budgeting, and investing. While the advice wasn’t inherently bad, I don’t think many of my classmates retained ...

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By the time you read this, I will have completed a transition to working half-time. Now, I know a lot of docs out there think emergency docs are already only working half-time, so perhaps I ought to start with explaining why that isn’t the case, even if emergency physicians work fewer hours than many other physicians. Let’s start with the fact that most Americans consider 35 to 40 hours a week ...

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“Check it out,” my boyfriend said, angling his rash-covered arms in front of the camera. Despite his best precautions, after a day of yard work, he was covered in poison ivy. Over video chat, he showed off the pustules that had erupted on his feet; I cringed. “It’s fine,” he said, wincing while putting his socks back on. “I’m glad to know how awful it feels. I’ve seen a bunch of ...

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Here are a few thoughts about the latest chapter in the never-ending debate about antibiotics vs. surgery for the treatment of uncomplicated appendicitis. You will recall the randomized controlled trial from Finland published in 2015 that found a 27% rate of failure of antibiotics within the first year. Now that the patients have now been followed for five years, 100 (39%) of the 246 patients treated with antibiotics have experienced persistent ...

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Not knowing what else to do after finishing my pediatric residency 15 years ago, I became a general pediatrician. Not knowing how to find a job halfway across the country and closer to home, I relied on a recruiter from a smallish town in South Dakota to woo me into private practice. Not knowing how to choose my future partners, I let them choose me. Despite my unbelievably naive approach to ...

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A vivid memory stands out from my career. Driving home from the hospital at 3 a.m., I reflected upon my most recent patient’s middle of the night delivery. It wasn’t an easy delivery, as they often aren’t. However, in the end, we had a healthy mom and baby and the family couldn’t have been happier -- nor could I. I felt a sense of gratitude as I was driving in the darkness ...

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A excerpt from A Mind Unraveled: A Memoir. Copyright © 2018 by Kurt Eichenwald. Published by Ballantine Books, an imprint of Random House, a division of Penguin Random House LLC. All rights reserved. I awoke in pain. Sometime during a seizure, I had fallen down the stairs outside of ...

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Elizabeth Warren describes medical bills as "the leading cause of personal bankruptcy" in the United States. She bases that opinion in part on her own research, in which she and her collaborators surveyed people who had experienced personal bankruptcy, asked them whether they'd experienced health-related financial distress, and concluded that 60 percent of all bankruptcies in the U.S. result from illness ...

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A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections. The patient was on the state Medicaid ...

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I had the fascinating experience of interviewing for residency at 20+ weeks’ pregnant. Although a number of people told me that I was doomed, I found the experience to be quite enlightening. Since I couldn’t hide the fact that life outside medicine was going to be important to me during residency, I felt empowered to ask the “don’t ask” questions during my interviews. What did I have to lose? The ...

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Recently, a generally healthy friend of mine had two small, unrelated surgeries over the course of a few months. For the first, a small operation on his hand, he received a prescription for 30 oxycodone pills. He used one the night after surgery, to make sure pain wouldn’t wake him. Over the next few days he used a few over the counter acetaminophen tablets for his modest discomfort, and then ...

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As we get older, time becomes are more valuable commodity.  I clearly remember that as a college student, I was more than willing to wait in line for over an hour simply to get a free sandwich promotion.  Nowadays, I’m not even too interested in waiting 20 minutes to be seated at a restaurant.  Our priorities evolve. One interesting aspect of time that remains relatively unchanged over time is our tolerance ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. It is not uncommon for my patients and their family members to ask for my credentials at the end of our preoperative interview. Despite reaching my forties, my Asian genes have allowed me to maintain a youthful appearance – often causing apprehension about ...

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So much of life depends upon timing. Sure, we plan, but we know how much of our life’s events are unplanned and unexpected. So often, our jobs and our mates -- two of our most defining accomplishments -- are the result of a chance encounter or a random act. Life does not reliably proceed in an orderly manner. This is often true in the medical profession. Here, physicians in our quest ...

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Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on. People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the essence of being a physician, what people ask for when they come to see us. Most ...

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