I've been practicing as an interventional pain management physician for over six years. It was a long road to get here -- four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, "You must really love what you do." Sure, during residency there was light at the end of the grueling tunnel ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated during a routine follow-up examination of multiple sclerosis, which was diagnosed 3 years ago. The patient says she wishes to discontinue her oral contraceptive and attempt to become pregnant. She has no other personal or family medical history of note. Medications are fingolimod, vitamin ...

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Mr. F points a slender index finger to the heavens and states calmly: “It’s OK doctor. Jesus will protect me.” I had just said I was sorry there was nothing more we could offer, and he was going to die. He understood … right? It had been a difficult few months for my unfortunate patient. He smiles at me softly, nasogastric tube cascading over his right cheek and then closes ...

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Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year. For the uninitiated, “work” as a medical ...

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Announce to friends that you have cancer, and they will probably react with sympathy and compassion. Tell them that you've broken your leg, and they'll offer to get your groceries and drive you to medical appointments. Share that you suffer from depression -- and the sound of silence will fill your head. Depression has been my companion for as long as I can remember. My maternal grandmother, who immigrated to this country ...

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It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift. Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so ...

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In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists. I will concentrate on anesthesia as it is my area of specialization, and I have some relevant ...

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Upon retiring from clinical medicine and becoming a full-time author/coach (I like to say I’m repurposed), I was uncertain as to the amount of taxes I needed to pay. I have a complicated tax return with several K-1s that don’t surface until March. My final return totals 32 pages for federal and 5 pages for state.  After making an estimate of my tax bill at year end, I figured I ...

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I teach first-year medical students how to take a medical history and perform physical exams on patients. These skills are the foundation of medicine. The history and physical exam (plus a few basic tests) are time-tested methods for diagnosing disease. Using these tools, a skilled physician can reach an accurate diagnosis more often than not. We humans share a standard range of symptoms. Pain, weight loss, fever, cough, abdominal complaints: They are ...

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Medical practice is a calling. It's not a job, it's not a career -- it's a vocation. And if you really love your vocation, you'll let nothing stand in your way. Certainly not something as trivial and crass as money. After all, once you're in practice, you'll be raking it in, right? So why worry about that now, when you're just beginning your medical education? That attitude is pervasive, and it's ...

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I’m a family doctor in upstate New York. My patients include active NRA members and ardent pacifists. Most probably fall somewhere in the middle -- they own guns for hunting or encourage neighbors to hunt the deer that feed on their lush gardens. As a mother, I tried not to let my boys play with toy guns when they were little. In a young boy’s imagination, though, everything became a gun ...

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Like all doctors, I am frustrated when I see my patients missing out on what could be years of good health. And our medical system is so dysfunctional that it’s tempting for doctors and patients to blame poor health outcomes on how we pay for medical care. But, our ridiculous payment system is a symptom, not the cause of our problems, and fixing our medical system is not going to ...

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Gun safety, gun rights. On reading these words, some have immediately assumed that I’m a far-left liberal who is proposing breaking into their homes, stealing their guns and melting them down to make a statue of a kneeling, gay football player to place on the National Mall. Still others have immediately assumed that I’m a far-right conservative speeding by in my rebel-flag-waving, coal-rolling, king cab pickup with my loaded AR-15 in the ...

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Financial independence is fantastic.  It allows you to wrangle free from the hum-drum existence of the W-2 asset class and aspire towards your individual life calling.  Maybe you want to start a non-for-profit.  Or volunteer at a local hospital. Or travel to the Galapagos islands and study the unique evolution of the flora and fauna.  Whatever your passions may be, there is no greater accelerator than freeing up forty ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The opioid epidemic has reached a tipping point. Overdose deaths involving prescription opioids have quadrupled since 1999, as safer pain management practices must be a national priority. Everyone in health care needs to be aware of the potential dangers and become part of ...

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Earlier this month, one of us visited a prominent U.S. medical school to give a lecture on the topic of burnout and how physicians can find more fulfillment in the practice of medicine. Sadly, that very day, a fourth-year medical student there took her own life. The problem was not personal failure. She had recently matched into a competitive residency program at the one of the nation’s most ...

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STAT_Logo I've watched enough television shows to know what a burned-out physician is supposed to look like: crying in the stairwell, head hanging dejectedly, knees bent; the downward spiral into drugs and alcohol that leads to a near-miss in surgery; or the final, explosive monologue that alienates the doctor in front of patients and peers. A once-solid doctor ...

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Where is everybody? It's a Wednesday morning, and after 8 o'clock grand rounds I headed back from the medical college auditorium to our practice, and as I walked back into the office our med-tech told me that my first two patients were already in their exam rooms. So I dove right in, starting with a husband and wife there for their annual physical exams, and I set about getting to my morning ...

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I am convinced that I have one of the best jobs a writer can possibly have. I practice medicine, in an emergency department. My life, every day, is filled with conversation with humans. I see their faces and touch their hands. They bring me their children, their very children (!) and trust this stranger to make their precious ones well. I hear their stories! Such stories. Of sorrow and sadness. Loss ...

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He looked tired and worn down, more so than many of the other patients I had seen that day. He didn’t speak English and I did not speak his language, but I could feel his anxiety as it filled the exam room. One of my employees translated, in fact, what his “boss” was telling us. The boss was worried that he was more tired than usual, and not getting his ...

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