Physicians are the building blocks of value-based care, yet the cumulative human and financial cost of our decisions are mostly hidden from us. Instead, our reality is analogous to being on a diet and a budget at a restaurant that doesn’t put prices or calorie counts on the menu. We need and want cost transparency. A survey from Deloitte University discovered cost is a part of ...

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After a semester of studying and taking written exams, we had our first OSCE in medical school. An OSCE — or an objective structured clinical examination — is the real deal. Instead of filling out multiple choice boxes, we instead work with a real human being, which for me is a welcome change. The actor is given a script with their unique condition and story — it’s a simulation of what ...

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In February 2017, I saw my last patient and left clinical medicine. Most people would say I retired. I have chosen to say I have repurposed. I no longer see patients, but I still work. I am writing the Doctors Guide series of books, keeping up a blog and working with physicians who need help with a financial makeover, usually to eliminate their debt, set themselves up for retirement or ...

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When I was 12, my father got into a bicycle accident resulting in traumatic brain injury. Although I was unaware of it at the time, this day became the first day of the rest of my life. Despite having never seen either of my parents so much as have a sip of wine with dinner, I watched my father spiral into a crippling alcohol addiction that wreaked havoc on our lives. As ...

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When you see your doctor, you want to know what’s wrong, follow the steps to recovery and get predictable results. Sadly, this is not always possible. Medicine is an art based on science that is constantly changing and full of things we don’t know. Here are four reasons why it seems like your doctors didn’t get it right — when we actually did:

  • Your symptoms or exam findings were not typical ...

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A 76-year-old gentleman with a history of kidney failure, myasthenia gravis and recently diagnosed with esophageal cancer presented for evaluation of melena and hypotension. The patient was my first admission to the medicine team as an intern, and he was as near to an ICU admission without actually being admitted to the ICU as one could come. After examining the patient, I briefly staffed with the busy attending physician, placed the ...

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How do I start a side hustle? I have heard this plea so often, It is no wonder there are many how to blog posts trying to answer this exact question.  As helpful as they may be, most of the ideas espoused are both time and energy-consuming.  For instance, starting a blog is great!  But if you want to truly make money, be prepared to put in full-time hours.  Or 
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On a weekend night, I received a strange phone call from an emergency room resident. “This is an emergency,” he said, adding fragments of details, “… vaginal bleeding … her heart rate is in the 150s.” It was hard to figure out what was happening and his tone was oddly calm. “Is she in an exam room?” I asked. “No,” he replied, “we’re in the trauma bay.” I ran downstairs with ...

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A warning about examining your friend's medical condition. Brad Nieder is a physician and comedian and can be reached at the Healthy Humorist.

CPR was first endorsed by the American Heart Association in 1963. When I took a Red Cross Life Saving Course in 1965, we learned about the “chest pressure arm lift” form of resuscitation which worked about as well as burning incense. I began working as an orderly in a community hospital in 1967. You probably remember that I was famous as the guy who first popularized wearing gloves when inserting ...

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Let me warn you — I own guns. I love to shoot. And I’m a strong supporter of the Second Amendment. This may seem hypocritical coming from a doctor, but don’t shoot me figuratively speaking, of course — before I make my case. Any mass killing is a horrifying event. Any senseless death is riveting. Obviously, this goes without saying, but as a doctor whose purpose is to save lives, ...

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In early April 2017, a cover of The New Yorker depicting four medical providers sparked a movement within surgery. Women surgeons claimed this illustration as a rallying cry; recreating it proudly with colleagues in the operating room and sharing their images on social media tagged with #NYerORCoverChallenge and #ILookLikeaSurgeon. We were in our fourth year of general surgery residency when we became the ...

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Consider this hypothetical addendum to a hospital discharge summary: ”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact ...

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I’ve interviewed many doctors on my podcast The Doctor’s Life. They share their stories of how they came to medicine and how they developed into the physicians that they are today. There are three common themes in these “origin stories”: The first is that many of the doctors were mentored by a physician who inspired them to pursue medicine. The second is that they were “called” ...

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Shortly after the publication of "Independent practice: Both nurse practitioners and physicians should be outraged," the nurse practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.” But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support ...

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Humans need human touch Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level. However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that's when the popular adage can be beneficially carried out in ...

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It is well known that smoking cigarettes negatively impacts health and leads to an increased risk of stroke, heart disease, lung cancer and death. No one debates this anymore. But it wasn’t always this way, and it didn’t come easily. In the 1940s, almost half of the population in the United States smoked, and the tobacco industry was subsequently incredibly powerful and politically active. It spent millions of ...

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For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications. As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable ...

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One late evening on pediatrics call, a frantic young couple brought in their few weeks old baby. She had spiked a fever which refused to go down and was fussier than normal. The cause of her symptoms could have been anything -- at best, a mild respiratory infection, in which case we would simply watch her and manage her symptoms, but at worst, it could be meningitis, an infection attacking ...

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"Low-Key MS3" from medical students at the Howard University College of Medicine.

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