What About Recovery” is a provocative essay by Yale professor Lenore Buckley, MD, in JAMA. She writes in detail about the death of her 68-year-old brother in a hospital. She felt his doctors did not do enough to help him recover because his nutritional and physical therapy needs were not met. However, there’s more to it. She calls out the system existing in every hospital I’m aware of writing, ...

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“Someday Syndrome” is prevalent in many walks of life, but it is particularly bad in medicine.  You know what I am talking about.  “Someday, when I have graduated medical school …” or perhaps the more common phrase is, “Someday, when I am an attending …” Phrases that start with this sort of expression imply that today is not good enough.  And I am here to tell you that if ...

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A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make life easier for the doctor; having somebody screen the calls, answer easy questions, and only call you ...

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Health care is a tough job to work in -- whether you are a doctor, nurse or any other professional. We are dealing with matters of life and death, our patients expect (and deserve) the best from us, and we always have a hundred-and-one things to do at the frontlines of medicine. I remember reading somewhere when I was a teenager that a career in medicine would be a “mentally, ...

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If my medical training taught me one thing, it was how to recognize the destructive nature of fads. They pervade our health care system. Most center around medicine, vitamins, and herbals. Though there also is no shortage of treatments and procedures that become popular very quickly and flame out over decades. Although one would think these spurious “advancements” would be pushed by a fringe agenda, it is actually commonplace for ...

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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. She has ...

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Much of the personal finance blogosphere directed at physicians spend time discussing spending money. And for good reason.  Physicians have a spending problem.  While I am all about educating people about their personal finance shortcomings, it is also important to find balance in life.  Some things in life are worth the money because they provide happiness despite not building your wealth.  One might even argue that these non-monetary ...

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It happens all too often. You have not been taking good care of yourself. You don’t eat, you sleep poorly, and you neglect your medical health. Over months or sometimes years, you begin to isolate yourself from your friends and family. You can’t seem to hold a job. You lose interest in once pleasurable activities. Your thinking becomes odd, your thoughts distorted and fragmented and strange. No one knows about that ...

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I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the ...

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“Burnout” has been a buzzword circulating in the medical community quite a bit lately. The World Health Organization has just recognized the term as an official medical diagnosis as part of ICD-11. One moment you’re graduating medical school, full of hope and excitement for residency. The next moment, you’re overly stressed and working insane hours every week. Honestly, it isn’t a huge surprise that nearly half of all physicians ...

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I wasn't as happy as I expected to be when I walked out of the hospital on my last day in medical school. But then again, there was little to celebrate -- my last few patients had terminal cancer, a stroke, and end-stage liver disease from alcoholism. I signed off my patients to my resident, and so, my medical school career came to an unceremonious end. I thought to myself ...

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The day of solo practitioners is coming to an end. In its place will be gaggles of gastroenterologists and flocks of physicians. Mega practices are becoming the norm in American medical care.

Here’s a few pictures of this trend, somewhat dated (they only go through 2015) but still quite revealing.

The figure below illustrates the distribution of primary care physicians in the U.S., from June 2013 ...

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I want to share some thoughts about artificial intelligence, or as I prefer to call it “data analytics.” Fundamentally: How can we capture the capability of analytics to improve the care and outcomes of cancer patients? And more importantly: How can we harness this technology to help bring back the human touch in cancer care? Admittedly that’s a large focus covering lots of opportunities. Speak to one expert, and you will ...

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Google that phrase, and you will come up with lots of hits. The following is a partial list of things that have been found to have more germs than a toilet seat: Kitchen cutting boards, sponges and sinks, refrigerators, spatulas, pet food bowls, clean laundry, smartphones, electronic tablets, computer keyboards, carpets, faucet handles, handbags, can openers, ice served in restaurants, menus, reusable shopping bags, TV remotes, ...

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Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails. Sometimes the broader use of a medication leads to additional FDA approved indications. One good example is bupropion, Wellbutrin, for smoking cessation. It even got a new name for that indication, Zyban, ...

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Two incomes are better than one, right?  As we all know, the answer isn’t clear cut.  If we have to actively “work” to generate income, we have to balance exchanging time for money.  Nothing comes for free.  When you throw in a tax system to convolute matters, certain households are actually punished for going into the workforce.  There is a delicate balance between each income-earning member and what each profession ...

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If you're a young doctor reading this, chances are you are employed by someone else. Your paycheck may come from a hospital system or a group of other doctors, but you're not your own boss. This may be working out just fine for you: I hope you are happy and have a well-balanced work and personal life, and are getting a fair paycheck. I hope you have a sense of ...

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When the paramedic calls in and says "transporting non-emergent …" I think of this wonderful story. I was once "deposed" by the state medical board to speak on behalf of a friend who had been charged with "unprofessional behavior," because he missed an abnormal lab that resulted in a patient having unforeseen (but non-lethal) complications. It was really a systems issue, but somebody thought my friend needed to be made an ...

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Every doctor and doctor-in-training has a particular thing that drew them toward a career in medicine. Whether it is an interest in science, a passion for service and helping others, a family role model, or a combination of the above, there are many ways to spark interest in the field. From my own experiences and conversations, I've found that finding inspiration to enter a career in medicine is rarely a ...

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My first job after residency was in a small mill town in central Maine. I joined two fifty something family doctors, one of whom was the son of the former town doctor. I felt like I was Dr. Kiley on Marcus Welby, MD. I didn't have a motorcycle, but I did have a snazzy SAAB 900. Will was a John Deere man, wore a flannel shirt and listened to A Prairie Home ...

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