While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a ...

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shutterstock_286268375 Flying on a return trip from Chicago to San Francisco, I can’t help but feel a little on edge. It’s not the fear of flying that is leaving me a little less relaxed than the pleasant, middle-aged woman peacefully slumbering in the seat next to me. It’s the possibility of hearing the announcement few doctors are comfortable hearing during travel: “Is ...

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Evidence-based medicine (EBM) has been classically described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”  At first look, this well-accepted approach to clinical medicine appears not only completely reasonable, but also somewhat obvious given the immense amount of research available for academic consumption. EBM has been repeatedly preached as the gold standard of clinical care across all medical ...

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We don’t even have to ask, and you certainly don’t need to get out your credentials. It’s so obvious that you are a medical student. And it’s not just the short white coat and student identification badge half-hidden in your linen pocket that says it all. We’ve seen you at all hours around the hospital during your clinical rotations. You tend to appear a half-hour before everyone else, just in time to commandeer ...

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Experiment 1. Stop five random people on your way to work and ask them to name the top public advocates of health and wellness that come to mind. Do I dare speculate that more than a few would mention Dr. Oz. Or Jenny McCarthy? Experiment 2. Stop five medical colleagues and ask them to list their top physician writers and journalists. Do I dare speculate that more than a few would only have ...

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We’ve almost made it. Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations. Post-graduate training is also nearing ...

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As the youngest member of a family of doctors, it was not uncommon during my childhood to spend summers at my father's private practice. I fondly remember greeting the familiar office staff as I recklessly ran amok among an endless array of rickety cabinets containing an untold amount of aging, yellowed paper charts. My dad's patients would tousle my hair like family and his partners would always leave an insurmountable ...

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shutterstock_202781149 You -- a medical student, resident physician or newly-minted medical attending -- are late in the game.  Sure, you appropriately hopped onto Facebook during your first few years of college, only to rightly disengage around the advent of newsfeeds and cover photos.  You passively signed up to LinkedIn last winter only to remain passively aware that your profile exists unfettered and ...

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We’ve gone through four dreadful pre-medical years of learning everything from the composition of atoms to how an apple exerts force when falling off a tree.  We’ve taken a massive exam full of content mostly unrelated to our future field only to be put through four more years of intense medical education (and several additional massive exams).  We’ve managed to receive a medical degree and have gone through at least ...

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night shift You’ve changed. No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other. We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night.  Your persistence to move ...

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As a resident of San Francisco (and with Los Angeles just a drive away), I cannot escape the food hate.  Whether it be a campaign against cooked provisions, farmed products or anything of solid consistency, I cannot help but wonder if any possible benefit of these diets outweigh the risk of missing out on amazing grub. But what about gluten-free diets? Gluten sensitivity Gluten, a protein found in foodstuffs such as wheat, barley ...

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As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures. While I am no means an expert of health policy nor medical business and financing, I think it's important for medical trainees and enthusiasts alike to understand the very general basics of ...

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Picture this. You walk into your doctor’s office for an urgent visit for new distressing symptoms.  He (or she) takes your blood pressure, temperature, heart rate.  All within normal limits.  He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two.  You ask him what he thinks is going on. The quandary If it’s a slam dunk diagnosis, the branch point in ...

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Recently, I had the fortune of hearing the tale of Bob and his bum knee.

It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru.  Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center.  After describing my work as a ...

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If you haven’t already, you will someday see a primary care physician (PCP). It’s practically unavoidable. The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult’s life and wellbeing. These responsibilities range from treating various health conditions, ushering patients in and out of hospitals, coordinating long-term medical decisions, and consulting with other specialists to better optimize patient care. Given that ...

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I get it.  It’s not rocket science.  But sometimes everyone in the field of medicine needs a bit of a refresher when it comes to keeping our patients happy. After all, it’s a two-way street with medical providers and patients: we provide and support ways to improve and maintain the personal health of our patients while our patients provide and support the health of our careers and livelihood.  We depend on ...

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Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood.  And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing to ...

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Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery. Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year.  It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, ...

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Last month marked the first anniversary of two very important milestones in my career in medicine: I began training as a physician and started writing about medicine.  Although perhaps not equally as demanding, both of these new activities in my life required overcoming steep learning curves and involved constant self-reflection and personal change. Writing medical humanities pieces for different media outlets has been and continues to be a source of personal ...

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Full Code.  Do not resuscitate.  Do not intubate. Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response. Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves. Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with ...

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