Karen smiled nervously, her swollen belly peeking out from under her stretched silver tank top. Six months pregnant with her first child, the eighteen-year-old had come to the WIC (Women, Infants, and Children) office for help with getting enough to eat. As a medical student with a background in nutrition advocacy and a future in pediatrics, I had asked to observe the WIC enrollment process.

Karen and ...

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If you asked me five years ago what my career goals were, I may have said something about getting more grant funding and writing more manuscripts so I could eventually become an independently funded physician-scientist. But honestly, at that time, I had no concept of the nitty-gritty details and emotional support that it would take to accomplish those goals. My primary research mentor was a notable figure in our field ...

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The patient was well over 6 feet tall and looked like he had recently lost weight. When he took off his winter coat and hung it over the back of the chair, I could see his scapulae like wings under his sweater. He folded himself into the chair and carefully crossed his legs. He sighed softly as he arranged his ...

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Experience and skills are not enough to assure the highest levels of success and sustainability with improvement initiatives in healthcare. The reason this is true has to do with ... quicksand. When I was a kid, quicksand seemed to show up in movies quite a bit. People would be on the beach or in the jungle walking on what seemed like solid ground and suddenly get stuck. In quicksand, you lose ...

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In an earlier post, I pointed out that there is no better chance of passing a Medicare for all health care plan through Congress in the coming years than there was in 1977, or 1993, or 2009. Then Elizabeth Warren showed us just how politically unrealistic single-payer health care is when she released her funding plan and then quickly backtracked to the public option ...

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When I first saw Jea-Hyoun, in a medical meet-cute straight out of a romantic comedy, she was being evaluated for thyroid cancer. I was an allergy/immunology fellow harried by a pile of paperwork. She was a patient, in the same building where she saw patients of her own as a psychiatry and family practice resident, preparing to see the specialist. We made awkward small talk in the hallway before she ...

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You’ve seen the ads, and you may have even gotten a flyer in the mail directly from your insurance company. Use an app to make a quick video call to get the medical care you need. No waiting rooms, no appointments, no having to be touched, or even sit in a room with a physician – just the magic of the internet, and you’ll get what you want. But will you ...

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James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water. You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn't ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. ...

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I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs. Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them. PAs and NPs have excellent skills My first rotation as a third-year medical student was in the emergency department. There was a ...

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If physicians are “muggers” and co-conspirators in “taking money away from the rest of us,” then journalists and economists are pontificating parasites who produce no goods or services of any real value. I don’t think either is true, but the recent attacks on physicians by economists Anne Case and Angus Deaton, and “media professional” Cynthia Weber Cascio, deserve to be called out. You ...

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I sometimes work as a church security volunteer.  And when I do it, I get to simply stand and watch.  Watch for someone sick or injured (we have defibrillators and wound care equipment).  Watch for someone coming to cause harm.  Watch in order to call the police.  Watch to keep the children safe. And it occurs to me, when I do it, that watching is incredibly important.  I know this as ...

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Of the nation’s 3.5 trillion in annual health care spending, 90 percent is for people with chronic and mental health conditions. How long can this continue? Can health care institutes afford not to engage in the 2020 wave of preventative care health care disruption? For those riding the disruption wave, the answer is simple. CMS alone is providing more than 80 billion in ...

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Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment. Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn't sufficiently address the structural factors that contribute to burnout in the first ...

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During a day of shadowing during my first year of medical school, the physician I was following had been running behind schedule and instructed me to keep the final patient company until he caught up. I knocked on the door and found myself facing a wide-eyed, middle-aged man staring down apprehensively at his severely bloated stomach. As I asked the patient what was going on, he suddenly looked up at me and ...

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I’ve often been struck by a painting of Maimonides in my medical school. The artwork features him holding pages of a book that say, “Teach thy tongue to say I do not know and thou shalt progress.” That quote resonates with me more each day. As a first-year MD student, I’ve uttered the words “I don’t know” much more than ever. I’ve discovered that, whether I’m naming nerves found in the ...

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The issue of noncompliance comes up repeatedly in patient care. Whether in the context of primary care or allied health care, in most situations, patients seem unreasonable and irresponsible when it comes to taking their medication, attending consultations, adjusting lifestyles, or heeding the advice of their providers. A critical examination presents the term "compliance" as negativistic and synonymous with victimization, powerlessness, and the inability to self-determine. Due to the gravity of some ...

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I carry you in my heart. Not your cold and quiet and still little body.  No. I carry the you that I never knew. The you that your parents grieve. The you that will never grow up. The you that laughed and played that nobody new will ever meet again. I carry you in my heart. It was that you that made me grit my teeth when I heard they were bringing your body ...

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A spirited discussion erupted over The Joint Commission’s role in prohibiting food in patient care areas: "Taking food and drink away from doctors and nurses is just cruel." The rumor that The Joint Commission is the enforcer of food and drink policies meant to starve clinicians has been around since I was working as a nurse in direct patient care capacities in the ‘80s and ‘90s. I’ve devoted plenty of time to clarifying my ...

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The start of a new decade seems more meaningful than the beginning of other new years. I tend to think more long-range at these mileposts. For 2020, I've made three resolutions that I hope will have a positive impact on my life for years to come: 1. Ramp up reading Starting now, I intend to consume more books on a regular basis. Crucial to meeting this goal will be diverting my gaze ...

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