I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.  Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.  Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.  But, keep in mind that these systems were not devised and implemented because physicians demanded them.  To the contrary, ...

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A career as a physician has traditionally been considered to be among the best vocations that talented students can pursue. That may no longer be the case. All too many doctors report that they are unhappy, frustrated, and even prepared to leave the profession. That should worry all of us. The physician burnout crisis is likely to affect our quality of care and our access to health ...

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STAT_LogoWhen the Human Genome Project began in 1990, bioethicists feared that giving people the results of genetic tests would do them a lot more harm than good. Experts feared that individuals who received genetic information about their future health status would be overwhelmed by depression or anxiety. Or as genetic testing became more widely available, it would ...

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When Michael Howard arrived for a checkup with his lung specialist, he was worried about how his body would cope with the heat and humidity of a Boston summer. “I lived in Florida for 14 years, and I moved back because the humidity was just too much,” Howard told pulmonologist Dr. Mary Rice as he settled into an exam room chair at a Beth Israel Deaconess HealthCare clinic. Howard, 57, has chronic obstructive pulmonary ...

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Falling through the cracks, when it comes to health care, is a bad thing, but the way things are going, it's getting harder and harder to avoid. Providers in every setting are bombarded on all sides with data, results, messages, and things crying out -- screaming -- for our attention. Take, for instance, the conundrum that appears when a patient is ...

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When we think about clinical reasoning, most talks focus on diagnostic errors and the reasons for those errors. The legacy of Kahneman and Tversky focuses on errors and the many named mistakes we make. We focus on avoiding errors, but their work and too often our teaching does not focus on the road to diagnostic excellence. Gary Klein, the pioneer of naturalistic decision making, has focused more on the road to ...

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As a young professional with many competing expenses, it is paramount for me to prioritize my spending. However, adhering to a strict budget can seem a bit daunting and restrictive. To get over this anxiety, I started out with a spending plan that mirrors the “50-30-20 rule” by allocating money into three different buckets: things I have to buy, things I want to buy, and things I should buy. Let ...

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I’m in the back of an ambulance rig driving 110 miles an hour down the highway with the lights and sirens blaring.   The knuckles of my right hand are crushed every four minutes as my patient has contractions.  She cries only a bit.  She’s sixteen and her last period was nine months ago, but she hasn’t seen any other physician before me. This last contraction was an intense one -- my ...

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I've always felt lucky and relieved when a cardiologist told me I seemed to be fine despite my heart condition. My condition, referred to as congenital, complete AV block, is estimated to affect between 1 in 15,000 to 22,000 live-born infants. The electrical block is more commonly seen among older, adult patients where it presents an acute pacemaker indication. Researchers don't know very much about what causes the condition prenatally or ...

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“Planned death.” When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery. When necessary, we prognosticate. But ...

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On July 8, 2019, the American Academy of Emergency Medicine wrote a letter to the American Medical Association, asking the organization to create a public campaign to support physician-led care. Noting concerns over the recent media crusade to promote nurse practitioner care to patients, including the American Association of Nurse Practitioners "We Choose NPs" campaign, the letter asks the American Medical Association to combat the ...

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"The Big Sick" is an intimidating name for a movie. I never know what to think when "sick" is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn't give you much insight, neither does the beginning of the film. It has nothing to do with illness. It's about a Pakistani standup comedian/Uber driver who starts dating a white girl, but ...

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"What's the most common missed fracture?" my supervising PA asked during my clinical rotation in the emergency department. "The second one," I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions. Unfortunately, I didn't always know ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old woman is evaluated in the emergency department for new-onset dependent edema that began 3 weeks ago. She says it is difficult to walk, and she has gained 4.5 kg (10 lb) of fluid weight. History is significant for obesity and hypertension. Her only medication is lisinopril. On physical ...

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Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results. The survival strategies of the interns in ...

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Something like one in seven people living in the U.S. have no health care insurance. In fact, the number of uninsured people has grown by 7 million since 2016. These numbers are atrocious. Embarrassing. Shameful, actually, in a country as wealthy as ours. We need to recommit ourselves to guaranteeing people access to affordable health care insurance.

And then we need to go one step ...

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In May 2019, headlines of a study out of University of Michigan hit the lay media: “New Doctors’ DNA Ages 6 Times Faster Than Normal in First Year.”  Using DNA samples submitted by medical residents across the country, the Intern Health Study measured telomere length before and after residents completed their intern years. Loss of telomere length has been associated with morbidity, mortality, and even depression. A ...

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Something I’ve been thinking about lately is the path that we’ve all been somewhat conditioned to take. And that is working really hard now so we can reap the rewards later. If you don’t work really hard now, you risk not being able to enjoy life when “later” finally comes. Does that sound familiar to you? Well, it should, because that’s the exact path we took to become successful in our careers. ...

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It took me decades of studying, training, hard work, and sleepless nights to become a doctor. In approximately five years, I became a successful writer, editor, columnist, and a whole array of other titles assigned to that type of work. In under 3 seconds, I became a chronic pain patient for the rest of my life. Around this time last year, I was taking my two dogs outdoors when they spotted ...

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Money and death. Sounds kind of morbid, right? But, that’s exactly what we are concerned within the financial independence community. We like to talk about the former and avoid the latter. Make no mistake, however, that all of our conversations have subtly interlaced the topic of mortality. Our time on this earth is limited. No matter what your specific why of financial independence, we all want to find identity, ...

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