As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life -- especially those that ...

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asco-logo I am a medical oncologist specializing in breast cancer. I often try to conceal what I do for a living when I meet people for the first time as it always leads down a particular road. “Is that so depressing? I don’t know how to deal with that all day, every day.” But in truth, it ...

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Yesterday, I had an eye-opening experience that made me reflect once again about relationships. During the afternoon, I had to attend a mandatory trauma simulation event. Since I am a surgeon, I am referring to physical traumas like traffic or firearms accidents, and just to be clear — psychological traumas are not included in these groups, even when I firmly believe that some of them would justify such an efficient and ...

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Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and ...

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A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years. History of Suboxone Suboxone was first approved by the FDA in 2002 to treat ...

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Technology can be both a blessing and a curse and nowhere is this more painfully evident than in the U.S. health care system. If technology is to be used to improve the patient-doctor relationship, its systems should be designed by physicians who understand these needs, not by regulators and health care conglomerates for whom business objectives are paramount. When it’s all about billing and meeting documentation checkboxes and hospital requirements, ...

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Medical school was a difficult adjustment for me. Coming from a blue-collar background and lacking a medical pedigree, I did not relate to most of my classmates, and I made very few friends. That changed when I met J., a second-generation physician-to-be without the competitive guile or sense of entitlement implicit in most of the medical students I had met. With a generous personality undoubtedly sculpted by the experience of motherhood, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for severe cramps associated with her menstrual periods. The cramps have worsened over the past year, and the discomfort is severe enough that she has periodically missed work. She reports no abnormal vaginal discharge. Menses are unchanged from her baseline pattern. She has tried ...

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Anyone who has worked in medicine for a long time well understands the power of the statement coming from an experienced person: “This kid looks sick.” That person could be a physician or nurse. Years of experience does tend to give one a sort of sixth sense for when to worry something serious is going on that just hasn’t shown itself fully yet. Seasoned parents can often provide the same ...

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A guest column by the American College of Emergency Physicians, exclusive to KevinMD.com. Emergency medical care in the United States is a unique success story. Born from military tactics, emergency medicine has grown exponentially in size and sophistication from its early days. What was once a patchwork of inspired professionals cobbled together at a moment’s notice is now a highly esteemed medical specialty; singularly trained and expertly equipped ...

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The season has opened, and panic has spread among senior year residents, chief residents, and hospitalists out in the community. Fellowship applications are live and being viewed by the programs applicants think they want to rank one, two, and three. These incredibly intelligent physicians are refreshing student document network daily now and soon to be hourly as the weeks go on. The anxiety is building as people are waiting to ...

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I was always worried about doing well on board exams. I didn’t want to simply pass them; I wanted to excel. Before I took exams, rumor had it that a person would have to intentionally fail Step 1, 2, or 3 and that failing Step 2 CS was virtually impossible. The truth, I learned, is that thousands of physicians-to-be fail one of these exams every year. I know, because I’m one ...

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A recent stir was created regarding a California pediatrician Dr. Bob Sears. Dr. Sears is sympathetic to parents who do not want their children vaccinated. Apparently, Dr. Sears got in trouble with the California State Medical Board for not producing medical records to support a parent's claim that their son could not take vaccines because of adverse reactions, including "loss of urinary function and going limp,” and instead, just taking ...

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In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and ...” the lead singer says, realizing where they’d crossed the line of tastefulness. His guitarist finishes his thought, “... and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever. During ...

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“After this, there is no turning back. You take the blue pill -- the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill -- you stay in Wonderland, and I show you how deep the rabbit hole goes. Remember: All I’m offering is the truth.” – Morpheus from The Matrix Many physicians submit to a life of sterility and dullness — ...

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As an advanced heart failure and transplant cardiologist, I witness plenty of tragedy. But I don’t lay awake at night anymore grieving bad outcomes — that is the privilege and purview of loved ones. While family and friends may move through Elizabeth Kubler-Ross’ classic stages of grief, doctors do not have that luxury. To give tragedies a purpose, I take three steps when faced with bad outcomes: Separate fault from ...

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“I remember you,” said Gracie with the look of having found a long-lost friend. “You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home.” I hesitated to ask, “How did he do?” Gracie went on to say that her husband had passed in the last month, yet lived nine months following our brief encounter in the ...

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After many years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world. Do I accept an invitation from a friend to get together or do I refuse it? If I refuse the invitation, depending on who issued it, it may be the last one I’ll receive ...

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I’ve written previously that financial independence is plan B.  Plan A, of course, is life.  Your work and time are precious, and life is too short to be wading through a morass of unhappiness only to get to some endpoint or goal. While I definitely believe in front-loading the sacrifice, the cost should not have to be misery.  Physicians, in particular, tend to look at their ...

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I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients. It has been an interesting journey. Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see everything from sore throats to people who left the emergency room in the middle of a workup ...

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