After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.”  Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?” After it’s told to you over and over again by your male co-residents and even some of my ...

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Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to ...

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An excerpt from Worthy. “Breakfast ready? Bacon smells good!” Mark finished buttoning his shirt and joined Linda at the kitchen table. “I Googled funding for my clinic, but I didn’t find what I was looking for,” Linda said, filling their mugs with steaming coffee. “There has to be something out there for me!” She banged her fist on ...

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Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.” We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain ...

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As a male medical student, I have developed a growing interest in and enthusiasm for recent efforts to raise awareness about workforce gender disparities in medicine. Though women comprise over 45 percent of resident physicians and 50 percent of medical students in the United States, research reveals deficits in key surrogate measures of successful integration. There are pay and promotion gaps, and women are much ...

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You may have heard of open-source software. When it comes to open-source, "free" has two meanings. First, you can download open-source programs at no cost. Second, "free" means freedom. The software is free in the sense that it belongs to you as much as it belongs to anyone else. If you download an open-source program, you can use it in any way you choose. You can use it forever as-is, ...

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From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality -- but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report ...

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Breathing is different when you know what your lungs look like.  I first realized this during a meditation session at Stanford’s Windhover building. The space -- a large, subdivided room -- is a self-described sanctuary in the heart of campus. The walls are mostly glass, broken up by long, clay-colored steel beams. Natural light, filtered through the surrounding trees, streams in to illuminate five larger-than-life paintings -- a series called “The ...

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It is not enough to know that a patient’s medical condition warrants an MRI. For most insurance companies, a diagnostic test of this sort requires what is known as a prior-authorization. But, the doctor saying the patient needs this test often fails. The insurance company has a certain guideline the patient must travel first before they will consider the test. For example, a patient with back pain and numbness in one ...

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It has become trendy in health policy circles to believe that behavioral economic interventions are the key to health system improvement. After all, traditional economic interventions like pay per performance have generated underwhelming results, with little or no change in physician behavior. Why not try a non-financial, psychological intervention: like performance feedback! Well, a study conducted in the last couple years in Switzerland raises questions about the effectiveness of ...

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To accomplish certain tasks, we need a little help from our friends. No one can do it all, although many of us are more resourceful than others. Some folks are adventurous and dive into a new arena with excitement. They may be tinkerers who aren’t afraid to play with new gadgets. Sure, they might break some china, but they are apt to widen their skill set and enrich their lives. ...

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A friend recently asked me, “Where do we go from here?” The friend was referring to our impasse with health care in America. The Democrats have failed to repair the Affordable Care Act, and the Republicans have failed to repeal or replace it. With the status quo, I can understand our health care system providing lower quality care compared to its counterpart industrialized nations. I can even tolerate lack of access to ...

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T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native ...

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The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010.  This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers. The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive ...

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When I walked into the hospital room with my team to meet him for the first time, what struck me was how young he looked. He was listed as 26 years old, but he looked younger than that. He looked so young that it was hard to believe he had served a tour in Iraq a few years prior, or that he likely saw things there that no one would ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical ...

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In loving memory of my grandfather, my first physician mentor. Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the ...

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There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available ...

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It is not unusual to see a patient for a timely transition of care visit after a hospital admission and within a minute of entering the exam room know with all the bones in your body that this person needs to go back into the hospital. The funny thing is that when that happens, if the patient has Medicare, we may indirectly suffer financially from such “avoidable readmissions.” We belong to ...

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As a medical student, I immortalized myself with my classmates when I informed a lecturing psychiatry professor that I considered Freud’s theories slightly more credible than the nuns’ tales about guardian angels. The lecturer ignored my obnoxious comment and continued his lecture. But Freudians have been on the defensive for the past decade. This trend culminated when the Library of Congress was forced to cancel a tribute to Freud in ...

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