I have noticed several articles describing how antibiotic development has bankrupted some pharmaceutical companies because there isn’t enough potential profit in a ten-day course to treat multi-resistant superbug infections. Chronic disease treatments, on the other hand, appear to be extremely profitable. A single month’s treatment with the newer diabetes drugs, COPD inhalers, or blood thinners costs over $500, which means well over $50,000 over an effective ten year patent for each ...

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"All of our patients, but especially our most vulnerable Spanish-speaking patients, need to hear concrete, meaningful, and practical instructions on how to care for each other when they live in large multi-generational families, and positive stories from people who have successfully managed infection with COVID-19. They need to hear that, as their physicians, we are here for them. I want them ...

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She started crying. This tough, capable, juggernaut of an ICU nurse looked just a little broken for a second while she cried. "It's not fair. It's immoral—or unethical. I don't know—I know it's the right thing. We have to protect the patients and staff but ... if it were my dad! I just … I can't go tell them that she can't come see him when we know he's going ...

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“I live and die by waveforms and not just a snippet.  I need to see the entire waveform and what led to an event to determine an intervention or root cause.” The intensive care specialist told me this with desperation in his voice. He’s the one who has to tell families that their loved one is gravely ill, that another cardiac event could happen at any time, without warning, or that ...

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As a physician epidemiologist and former public health official, I find myself confused by people's perceptions of risk related to coronavirus, particularly as we struggle to reopen our economy amidst a surge of cases. I'll meet an older adult with diabetes who could care less about distancing or masks, but then a healthy person in their 30's too afraid to walk outside. I'll encounter a mother who is too ...

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Sneeze, and you miss it: the public’s love for health care workers. This relationship has felt like a true Coronacoaster. Pre-COVID: physicians were disparaged for the sins of insurers and hospital C-suites. COVID appears: I was gifted a yard full of signage announcing “Heroes Live Here.” COVID escalates: the World Health Organization is ...  defunded? We’re held in high suspicion, yet ...

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Two of the biggest hitters in the physician finance online world are both anesthesiologists (Physician on Fire and Passive Income MD).  Both of them are masters of side income by approaching money in completely different directions.  Is it sheer randomness that out of dozens of possible medical fields, both of these successful ...

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"Trainees like myself travel great distances from home in pursuit of higher edification. Yet the coronavirus makes us worry about the aged family we leave behind – parents and grandparents. A WhatsApp message ensuring they’ve stocked up on acetaminophen, toilet paper and canned soup (low sodium, of course) the only assuage to our anguish. The rigors of medicine often demand sacrifice, sometimes ...

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Setting: An impersonal, windowless conference room within a hospital Characters: A nurse in charge (NIC), a department chair (DC) and me (ME) *** NIC: Thank you for joining us to discuss the report you made of unprofessional behavior in the operating room. We’d like to start by letting you know that in this institution, we have a culture of informality. When I first got here, I found it unsettling that doctors were called ...

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Today at work, a mother asked me what I would do if it was my son in the isolette and not hers. It’s not the first time I have been asked this. I understand where the question comes from, and yet I’m at a loss of what to say every time. Not because I haven’t pondered it before. No. It’s because I have asked myself the question far too many times: ...

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Almost overnight, the COVID-19 pandemic has completely disrupted how we deliver primary care to patients. Before the pandemic, telehealth seemed to be a way to deliver urgent care for acute issues to a select group of tech-savvy patients. Now, at least in my practice, the majority of primary care (acute care, chronic disease management, and preventive care) is being delivered through “telehealth,” meaning that we conduct visits virtually via video ...

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Amidst the tangle of mail consisting of grocery ads and a retirement fund quarterly report and the membership renewal form for the botanical gardens, I spot a small manilla envelope emblazoned with the return address of my children’s school. This is what I have been waiting for with equal parts hope and dread. Last year was supposed to be the beginning of a new era for me — the year that ...

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I looked at a free book chapter from Harvard Businesses Review today and saw a striking graph illustrating what we’re up against in primary care today, and I remembered a post I wrote eight years ago about burnout skills. Some things we do, some challenges we overcome, energize us, or even feed our souls because of how they resonate with our true selves. Think of mastering something like ...

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"We do not have to continue to blame external forces for the stresses upon us now. By organizing, mobilizing, and finding solutions to the problems facing us and our adopted community today, we can meet the current challenge to be of help, however we can. Perhaps, in this way, we can stop making pandemics a future generation’s problem to solve, and ...

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When my son was in third grade, his class took a field trip to the Spanish Military Hospital Museum in St. Augustine, Florida. This was a military facility that operated in the late 18th century. It operated at a time when St. Augustine changed hands from Spain to England and then back to Spain. The museum provides tours that recreate the bygone hospital practices. Actors put on a full surgical ...

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A recent report by Merritt Hawkins, the physician recruiting firm, includes two key revelations about the impact of the COVID-19 crisis on physicians: Merritt Hawkins’ searches on behalf of prospective employers have dropped by 30 percent since March 31, and up to 35 percent of practices in some markets might soon close because of their unsustainable financial losses. As of late May, visits to physicians—both in-person and ...

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No matter what kind of day you are having, when you open up your email and see that subject line, it takes your breath away. While it could be a notice that Jeni’s is out of salted caramel ice cream, you know that’s not likely the topic. So, you take a deep breath, and you open it. Ten days ago, I woke up with a fever, sore throat, and couldn’t smell ...

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A man outfitted in a lovely blue suit falls through the air, losing his shoe and hurriedly scribbling notes, seemingly ignorant to the gravitational chaos around him. While this picture is featured on the cover of the novel Less by Andrew Sean Greer, I wonder how similar my experience will be starting on Monday. After four months of delay, it is finally my turn to enter the hospital and begin my ...

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It’s something we are taught from when we are very young and is a core middle class belief: work hard, get a qualification, and then you’ll be able to find a good employer who will send you a nice paycheck every month. On some levels, this seems like an attractive option. Yet on so many others, it falls apart. For physicians in the United States, the concept of “employment” is relatively ...

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"It is OK to be scared, but it is not OK to let our own anxieties harm our patients. As we tackle the numerous crises created by the COVID-19 pandemic, let’s acknowledge our fear and draw on the logic and clinical reasoning that we have spent years cultivating. We can be scared and scientific, anxious, but courageous. Let’s not create two ...

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