Dr. Hasan Shanawani was overcome by frustration. So, last week he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system. It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring ...

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Something funny has happened over the last year. I used to self identify as a physician. It was a large part of who I supposed myself to be. Of course, I was more than just that. I was a spouse and father, a brother and a son, and all the various other ways in which we see ourselves. But reaching financial independence and pursuing half retirement has sparked a ...

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As the U.S. endures its largest measles outbreak in 25 years -- one that’s almost certainly going to get worse before it gets better -- we’re getting a lot of calls and questions at my office. What’s measles, what’s the best way to prevent it, when should the vaccine be given to adults and children? The measles vaccine is given as “MMR,” which teaches the immune system to fight off measles, ...

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asco-logo It’s become a common practice in oncology institutions across North America: A patient completes their prescribed course of treatment and they ring a bell. Usually, it's a large bell, like one that used to be rung in schools signaling the end of recess. Or it's a ship's bell, attached to a wall outside the radiation department or the chemotherapy unit. ...

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In one of the recent physician burnout and depression surveys, doctors were asked to name the causes of their burnout.  The typical culprits were listed: lack of autonomy, EMRs, lack of support from administrators, insurance companies, lack of time with patients, and so on.  However, when they were asked what would improve their burnout, getting paid more was the number 2 cause.  Apparently, I am not the only ...

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A couple weeks ago, I called up my family and non-med-school friends: "For the next couple months, pretend like I'm backpacking in the Himalayas," I said. Pretend, I stressed, because, in reality, I don't even intend to leave Palo Alto much in the coming months. I've now entered one of the most-dreaded phases of med school: preparing for the first licensing exam, Step 1. During this time -- which can last as long ...

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We seem to get a ton of questions on the Passive Income Docs Facebook group about how to start investing in real estate. It can initially be a very intimidating venture. I remember when I started with a $5,000 investment in a crowdfunded deal. It was downright scary. I’ll be honest, I didn’t have a great grasp of what I was investing in. However, I knew that ...

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Reuters recently published an article on skilled nursing facilities and post-hospital stays.  They discussed the often-lengthy time between hospital discharge and the patient being seen by a physician or “an advanced care practitioner.” Older, more infirm and cognitively impaired patients tend to be seen later than other patients. The later you are seen, the more likely it is that you will be sent back to the acute care ...

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A call came about noon a few years ago that a patient I'll call Stella was being admitted once again. She had come into the ER from her nursing home to receive transfusions. These were now needed every two weeks to keep her alive. The problem was that every time Stella was moved she decompensated. Her Alzheimer's was severe. She no longer recognized her family. She was now 83 and slowly ...

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The solution to most of my work related problems was half retirement. By leaving clinical practice and taking a less arduous administrative role, I was able to divorce myself from the worst part of doctoring. Being financially independent helped, but wouldn’t have been the complete solution. I am not ready to retire. I would be remiss, however, if I didn’t also point out the downsides. The part-time blues ...

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Even during medical school, there was always the running joke about getting kidney stones. With the frenetic pace of many rotations, it was always difficult to squeeze in bathroom time, and I suspect many of us adopted the same solution – drink less water. That is certainly how I survived my month on vascular surgery. After a nine-hour case, I was told by one of the residents that everyone was ...

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“Medicine robbed me of my 20s.” I’ve heard the line many times in my medical training. It often comes accompanied by a long sigh, a slow sip of coffee, and a glazed stare off into the distance. “Imagine what could’ve been,” the seasoned physician muses, “if I had my 20s to do over, without medicine.” But now, I am mere months away from leaving my 20s behind. To be completely honest, I often feel similar ...

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Reading the headlines in the morning newspaper lately can downright depressing. It was with that feeling that I recalled three conversations I had recently with people who have various cancers. And I realized that despite all the chaos around us, maybe it’s time to say something in praise of hope. Hope is very real, especially when you or a loved one or someone you know is diagnosed and treated for cancer. Hope ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old man is evaluated during a follow-up visit. He initially presented with a 3-month history of chest pressure and dyspnea that occurred primarily with exertion. Despite maximal medical therapy, his symptoms have not abated and adversely affect his quality of life. Medical history is significant for type 2 ...

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Health care reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients. This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills ...

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A large percentage of doctors end up switching jobs within the first five years of practice.  This really isn’t surprising given that the medical training experience doesn’t necessarily correlate with the medical practice experience. Many doctors work hard throughout their entire training only to realize that their expectations do not necessarily align with reality.  Is it our fault that we don’t really know what we got ourselves into? Perhaps taking q3 ...

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Most Americans live their lives on borrowed money, constantly spending a little more than they make, leaving them with a growing debt. These debt payments, and the added interest they must pay on their debt, decreases the amount of money that they have available to spend on future needs. Paradoxically, borrowing to buy depreciating items, decreases one’s net worth. Stop the madness this year. No more spending more than you make. ...

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Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability ...

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The World Health Organization describes universal health coverage -- a system coupling health care access with financial protection for all residents -- as the “single most powerful concept that public health has to offer.” The goal of universal care is to give all people the equal opportunity to enjoy the best health possible. I wholeheartedly endorse universal health care, though not a single-payer system like "Medicare for all" because there is ...

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Talk about physician burnout and job dissatisfaction is everywhere right now. If you are a doctor, you cannot escape the news. Within the last couple of weeks, organizations in Massachusetts (a mecca of healthcare and hospitals) declared physician burnout a “major public health crisis.” This all sounds rather dramatic. On the surface, physicians are reasonably well paid, still enjoy a good degree of autonomy (certainly compared with many other ...

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