”You are the average of the five people you spend the most time with.” You may have heard this quote, from famous motivational speaker Jim Rohn, many times before. Taken at face value, the quote relates to how we are influenced. But it’s also a sentiment that really sums up how we live and interact with our closest friends and family. Tony Robbins takes it a step further, saying that “the quality of ...

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Just the other day, while I was in the middle of seeing a morning schedule full of patients, I opened one patient's chart and was thrilled to see a whole bunch of new icons in Chart Review in the electronic health record that I had never seen before. These apparently indicate office visits and other health care encounters with outside providers. Sometime during ...

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It was an ordinary afternoon in my outpatient internal medicine rotation. I prepared to enter a room for a congestive heart failure hospital follow-up patient. I mentally prepared myself. I was going to ask for his hospital records (particularly looking for the echocardiogram), make sure he was started on an ACE inhibitor and a beta-blocker, and ensure he had a follow up with a cardiologist in the coming weeks. “This ...

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Yes, we think it does. And the time to act has come. The time is now. We -- physicians and nurses -- work side-by-side caring for patients, every single hour of every single day. But we don't often talk to each other about the (seemingly insurmountable) deep and serious issues and challenges we as clinicians face, practicing in today's broken health care system. That has to end. We must unite. We are ...

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My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now.  The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly. This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent.  Most of the members of the hospital medical staff have absolutely no ...

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asco-logo Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their ...

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Much media attention has been paid to the new guidelines from American College of Cardiology/American Heart Association (ACC/AHA) on the primary prevention of cardiovascular disease. Based on new clinical trial data, ACC/AHA no longer recommends that healthy adults without cardiovascular disease -- emphasis on without cardiovascular disease -- take daily aspirin for the primary prevention of cardiovascular disease. This change, while significant, is highly nuanced and dependent on ...

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One of the things I am most grateful for, as a doctor who has worked in at least a dozen different hospitals over the last decade, is the broad range of experiences I’ve had and the variety of physicians I’ve met and gotten to know. I enjoy hearing experienced physicians’ perspectives on how the practice of medicine has changed from what it used to be in the 1970s to 1990s. I ...

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Owning a medical business is like being a CEO, patient advocate, accountant, human resources manager, medical healer, and office manager all rolled into one.  One job title that most physicians put last in their ever-growing list of roles is that of retirement planner.  Ensuring that you have your long term financial house in order is often neglected in favor of dealing with all the short term problems that a medical ...

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All good doctors learn to filter what parents say to them during history taking, to examine each parental statement for reliability, likelihood, and sheer outlandishness. Parents of sick children are a cross-section of humanity and, like all of us, vary in their observational skills, their ability to express themselves, and their tendency to exaggerate or minimize what they see. Parents, not being physicians, may not notice and comment on things ...

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As resident physicians with a tight budget, one of the last things on our mind is paying for added insurance. Trust me; I get it. However, as a [future] high-income earners, long-term disability insurance is essential. It may not be at the top of our priority list, but it should be. What is it and who needs it? Unless you are already financially independent or were lucky enough to have a trust ...

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The tale is told of a large realm, of 1.4 billion, the largest nation in the world. It has a culture that is old, rich and grounded. A citizen’s worth can be understood, determined, exalted or decried. In modern times said country has a visionary leader for life. His foresight includes the automation of culture through the use of big datasets, mass surveillance, facial recognition, and artificial intelligence. A citizen’s ...

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I can vividly remember the day the phone call came. My cousin screaming over the phone, trying to make out words but unable to speak, disbelief, horror, the fear in her voice palpable even though she was thousands of miles away. It was barely 5:30 a.m., I was frantically rushing out to beat traffic, hoping to get a head start on pre rounding since I was on call. Confused, I ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I vividly remember the first time I saw someone who had died. She was in her late 20s, wearing tattered clothes, and alone. Her friends and family never came. I watched from a distance as police and crime scene investigators worked. I had ...

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Our community had one of “those” providers — a midlevel who was the local pain person. If you had pain, go to her. She would write you for anything you could want and more. It’s unclear if she was unscrupulous or just inept. But last year, the DEA finally figured out what she was doing and yanked her license. There was nothing in the news. Nothing on the internet. We ...

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When I told my colleagues that I was going to try to create the first psychiatry review course at the University of Toronto, I received the same two responses: "It's about time somebody did that!" and "What is wrong with you?" — sometimes from the same person! The first reaction taps into the excellence of our department. With approximately 1000 faculty with diverse expertise and the largest residency program in Canada, ...

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The U.S. health care "system" is completely and utterly broken. According to the World Health Organization (WHO), the U.S. system ranks 37th in the world, all while spending dramatically more on health care than other wealthy countries. Tens of millions remain without any health insurance coverage. For many, medical bills can mean economic ruin — some surveys show that up to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The ...

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"I have the CPAP machine. I've had it for a year, but I don't have electricity in my house. I stayed with my aunt who has electricity but things didn't work out," said the young Navajo man, his massive belly protruding out from underneath the tray table. The old Navajo man with Parkinson's disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal ...

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What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the ...

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