“Breathe in slowly, deeply, giving fresh energy to your body. Breathe out, releasing any tension from your day. In … 1 … 2 … 3 … 4 … Out … 4 … 3 … 2 … 1 …” I try to follow the yoga instructor, but in my post-call fog, I struggle to let go of the last 24 hours. We begin by sitting poses to stretch our necks. But my neck is so ...

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Mine was an unusually long hiatus from residency for research training. And in the rough readjustment to clinical environments and work processes, one forgotten element seemed glaringly problematic: “Have a plan,” said one attending, “If you don’t know, just guess.” And another, in a teaching session, “Just guess, even if you’re wrong.” From a chief resident during an awkward pause when a junior was put on the spot: “Just guess; it’s OK.” When ...

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I’ll be the first to admit that I am a frugal physician. Frugality has served me well, and I wouldn’t be financially independent without that quality. Yes, I refer to frugality as a quality, and as far as qualities go, it’s a quality quality to have. While not everyone thinks of frugality as a decidedly positive quality to possess, it just might be that others confuse frugality with its ...

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Back in the grueling training days of my residency, I was the first-hand victim of theft. Not the kind you see on the big screen, where you're held up at gunpoint, or the kind where your belongings get ransacked. It was worse, at least in the way that it made me feel. I had my handbag stolen from me, right from its usual resting place on the shelf near my ...

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As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I'd yearn for my pager to go off. I was always tired, too — but for a surgical resident, fatigue is a given. Sleep and eat when you can, get your work done and operate like a madwoman: That ...

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The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era.   The paper medical chart I used during most of my career never "crashed."  Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed.  Although I appear to the patients as a breathing and willing medical practitioner, I might as ...

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Online dating is all the rage these days. Statistics suggest that over a third of couples now meet online. For a lot of older readers of this blog, who met their husband or wife the traditional way and are baffled by this whole new world (and don’t get me wrong, there were probably many ways in which those days were better!), whether you understand the whole online or app dating ...

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One of my readers, Natalie, wondered about my thoughts about the digital pill. My initial reactions were similar to several of those who were interviewed for the article. The digital pill, which provides electronic information to confirm whether someone has ingested the medication, has great potential to become a tool of coercion. Aripiprazole (Abilify) is classified as an antipsychotic medication, which is often prescribed to people who have beliefs that machines ...

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From the earliest days on the clinical wards, everyone probably worked with a senior physician who knew how to game the system. It might be doing a rigid sigmoidoscopy on admission for every patient who had a rectum — something not the standard of care forty years ago. Or maybe it was accepting a pharmaceutical company subsidized tax-deductible junket under the guise of CME at a place with sparkling white ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection. On physical examination, he is a young, healthy-appearing man. Vital signs ...

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When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in health care in the world he had to appeal not so much to their morals, but their pockets. There is much piety about the NHS. It is the envy of the ...

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Medical residents take on a variety of responsibilities. Some are clear, upfront, and obvious: the responsibilities they have been training for since entering medical school. Coming up with a treatment plan and carrying it out is first and foremost their raison d'etre, and they put an enormous amount of effort into it. However, they also acquire a host of other duties. They run interference for attendings. They coordinate with nursing. ...

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So you made a mistake. I know you’re busy beating yourself up about it. I know that after years and years of training in life-saving medicine you’ve also trained yourself to accept the blame for all sorts of things beyond your control. You’re asking, "How could I have missed that," or "Why didn’t I think about that?" You’re wondering why you didn’t give a different drug, order another test or do ...

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Humans evolved with the constant force of the earth’s gravity. This is relevant to several of our organs, but the brain’s anatomy makes it especially important. The brain floats in spinal fluid encased inside the closed box of the skull. Gravity would be expected to affect the details of that. Indeed, studies of people who spent prolonged periods of time in bed in a head down position indicate this abnormal ...

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Multiple state leaders, including Maryland Gov. Larry Hogan, and even President Trump have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails. Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely ...

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Anyone with even the slightest passing interest in health care, has heard the mind-blowing statistics. As a nation, we spend almost 3.5 trillion dollars on health care. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of 3.4 trillion dollars. At 18 percent of the economy, we ...

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I was born in Shanghai, China. In September 2000, my parents and I left behind our family and friends, a language and culture dear to our hearts and social and financial stability to immigrate to the United States. I was six at the time. Although I don’t claim to have fully understood the weight of their decision to start a new life, I knew that my parents were making a ...

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The only time my husband outearned me was during our first three years of marriage when I was still in residency and working 80-plus hours per week earning less than minimum wage per hour. Since then, despite graduating in a professional degree, we have made relocation moves that primarily help with my career growth, to the detriment of his. In 2015, an NPR article quoted statistics showing that 38 percent of ...

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Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even ...

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“In the beginner’s mind there are many possibilities, but in the expert's view, there are few.” Shunryu Suzuki was writing about Zen beginners and masters, but this concept applies to the practice of medicine as well. Experienced physicians are slow to accept a new paradigm, while medical students and new physicians are more open. Sometimes, what we “know” to be true is not. Despite clinical trials to the ...

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