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Think all the way back to your grade school years. Did you know that your personality traits were starting to be honed for the work you do today? Let me give you some examples about myself and see if you can relate. I remember the praise and exhilaration of being the only kid in the class to get a 100 percent on an extremely difficult second-grade spelling test.  My teacher told ...

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I’ve been concerned lately. Here’s why. In 2001, I got sick with what the doctors assumed was an acute viral infection, but I never recovered. I’m mostly housebound, often bedbound. My diagnosis is the little understood (but much misunderstood) myalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS. I describe it as “the flu without the fever.” This means that fatigue is only one of many symptoms I contend with ...

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Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model. On the first track, ARC and other ACOs assume “upside risk,” getting rewarded for taking on overall ...

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A few years ago, I wrote a KevinMD blog post about how cumbersome it was to complete notes in the electronic medical record (EMR). I proposed a solution in our residency clinic but encountered resistance in the adoption process that eventually led to its abandonment. For someone just trying to solve a problem, it was very frustrating, to say the least. Despite the advances in the past few ...

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You may have noticed your child seems to be bored of their bag lunch and most of it being brought back home or dumped in the garbage. Lunch is an important meal to get kids the energy they need to get through the second half of the school day. Strive to include some protein, fruits, veggies and healthy sources of fats. Now, you don’t have to buy gourmet or even ...

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At midnight on February 15th, if Republicans and Democrats don’t come to an agreement about border security funding, the American people will be facing the possibility of a third government shutdown since President Trump took office. The most recent government shutdown -- the longest in history at 35 days -- left nearly 800,000 Americans furloughed or working without pay. Federal benefits that millions of Americans depend on, such as the ...

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Once again, we find ourselves stuck between a rock and a hard place. Increasingly, providers are being pressured to improve access for our patients, which we certainly think is a good thing. We want our patients to come in, whether it's for their annual physicals, for ongoing routine management of their chronic health conditions, or for acute issues best handled in the ...

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Physician Speaking by KevinMD is a boutique speakers bureau founded by Kevin Pho, MD. Today’s spotlight physician speaker is Dr. C. Nicole Swiner. C. Nicole Swiner, MD, known as “DocSwiner,” is a family physician, two-time best-selling author, blogger, speaker, wife, and mother. She was voted as one of the 10 best doctors in North Carolina in 2017 and is also affectionately known as the “Superwoman Complex” expert and ...

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Studies have shown that video games and other addictions, such as alcohol and nicotine, affect neural pathways in similar ways: They all lead to an increase in dopamine levels in specific pleasure centers of the brain. While drugs increase dopamine levels far more than video games, gaming can have a similar deleterious effect of “taking over” a person’s life. One of the key ways that gaming addiction differs from other addictions is ...

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I lost my attending to suicide. A lot of things about life changed that day. In the days of grief that followed, I was consoled by my mentor who suggested we meet outside on a patch of grass near the hospital. As we shrinks say, we needed time to emotionally process. I remember being grateful that I was going to get fresh air. The hospital felt suffocated by the all too ...

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Why is your hospital always full? Actually, it’s more than full.  You have twenty boarders in the ED. You turned your postop recovery unit into an overnight surge center.  Every day administrators beg you to please, please discharge patients, if possible before 11 a.m.  You’ve hired an army of case managers, dissected the discharge process, and held countless capacity management meetings, but you’re still bursting at the seams. It wasn’t always ...

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Did you feel a pop? It is a simple question that we rattle off to complete our musculoskeletal history. The answer may or may not give higher suspicion for a diagnosis of tear over sprains. But have you — the provider — ever felt a pop? Like any good physiatrist, I try to fill my extracurricular time with physical activity. This inevitably led to the formation of a residency street hockey team. Ten minutes ...

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I barely remember walking out of the hospital that day. After a nearly 30-hour residency shift, I was in a bit of a daze. I trudged across the main parking lot, staring absently at the coffee-colored snow beneath my boots. I have no memory of reaching the crosswalk to the main road or even stepping on to it. What I do recall is the loud, startling screech of brakes. “Did you ...

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I lost my sense of empathy when I worked as a pediatrician in a pediatric emergency department caring primarily for low-acuity patients. I worked there for ten years, but it only took about three years before I realized that while I could help kids with their symptoms, I couldn’t do anything about the reasons they were in the ED at 3 a.m. These kids don’t have reliable transportation to get ...

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Florence Nightingale was among the first nurses who started wearing a nurse’s cap. The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap. Back then becoming a nurse was typically seen as a female profession, but men were allowed to become nurses too. In 1930, only one percent of RNs nationwide were male. Growing up in the 1950s ...

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After teaching biology and nutrition for three years, I began my journey back to my original dream: a career in medicine. The most common sense approach to me was to return back to college and start taking the necessary pre-requisites to apply for medical school. My original major in college begin special education, I had no previous college-level science background, so I began taking introductory biology and chemistry at a ...

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“I drank beer with my friends. Almost everyone did.” Alcohol has become constitutional to American culture: “grabbing a drink” after work, happy hour, cheers before meals, on New Year’s, or just because. Our society’s normalization of drinking creates a slippery slope toward excessive alcohol use. Unhealthy alcohol use is rampant: one in six Americans drinks excessively four times a month, according to the Centers for Disease Control (CDC). Almost thirty percent ...

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I hate repeating myself.  It’s an impatient quality, but I wish everyone could just hear me the first time.  With a surgical personality, I prefer to convey things in the most efficient way possible, i.e., “Blade!” or “Kelly, please.”  So when folks ask me to repeat myself repeatedly, I feel my inner voice protesting, “This is so inefficient, ahh!” If someone repeats something they have already told me, and catches me ...

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From the beginning of medical school, one of the first things “instructional videos” that we had to watch during orientation was about “social media” and what “not to do.” There began this stigma, and it was frowned upon to use social media if you were a clinician. There are the obvious things that physicians should not do, such as post private information about patients, show a patient’s face without their permission, ...

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