An open letter to the American Board of Family Medicine (ABFM): I recently chose to sit for my sixth (and I hope final) family practice maintenance of certification (MOC) examination, having now practiced as a board certified family physician for the past 34 years and intending to work a few more years. I want to share my experience taking this examination your organization prepares, promotes and uses at a high cost ...

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As we drown in the overwhelm of modern day health care duties, most physicians I know, including myself, fail to follow their own advice. Far too many of us have become overly tired, irritable and resentful about our workload.  It is difficult to look forward to the dawn of the next work day. Medical journals and blogs label this as “physician burnout” but the reality is very few of us are ...

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I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door. In a typical clinic day, I open that door up to thirty plus times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient.  I need to peel through the layers of each person quickly to find the core of truth about who they ...

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shutterstock_161298866 "The chief difficulty Alice found at first was in managing her flamingo: She succeeded in getting its body tucked away, comfortably enough, under her arm, with its legs hanging down, but generally, just as she had got its neck nicely straightened out, and was going to give the hedgehog a blow with its head, it would twist itself round and look up ...

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Disneyland is in the news, and not because it is the most magical place on earth.   It also is the origin of the most recent rubeola measles outbreak, now spread to seven states and Mexico with over eighty cases diagnosed so far.  Unvaccinated children are being kept home from school in some California districts and vaccination requirements once again have become a battleground between  public health agencies and the “right ...

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janis babson I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning,  reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been ...

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'Tis the season to be coughing ... It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season.  For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world. Or just ask a primary care clinic what its waiting room sounds like these days.   A chorus of coughs, high, ...

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This is a speech I gave recently at our local hospital when I was given a "physician of the year" award for my work managing medical detox in our community for 20 years. At first, when I was told about this honor, I was really unsure why my clinical work in medical detox would warrant "physician of the year." I am not as skilled a diagnostician as many of you. I’m not ...

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Several years ago, a young woman I’d been seeing in clinic weekly for about a month to initiate treatment for depression called late Friday afternoon to cancel an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who cancel and do not reschedule. It gave me a bad feeling that she was not following through on her treatment plan and ...

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shutterstock_94195759 This wasn’t just plain terrible, this was fancy terrible. This was terrible with raisins in it. -Dorothy Parker More and more of my clinic time is devoted to evaluation and treatment of depression and anxiety rather than sore throats, coughs, UTIs and sprains/strains.  An outbreak of overwhelming misery is climbing to epidemic proportions in our society. A majority of the patients who are coming in for ...

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Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy. -Mark Twain Returning to clinic after time off for a summer break, I worry I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake.  Just maybe no one will notice I don’t ...

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shutterstock_118283776 Nothing was helping.  Everything had been tried for a week of the most intensive critical care possible.  A twenty year old man, completely healthy only two weeks previously, was holding on to life by a mere thread and nothing and no one could stop his dying. His battle had been lost against MRSA pneumonia precipitated by a brief influenza-like illness.   Despite aggressive hemodynamic, ...

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Even doctors must become patients eventually, and often challenging patients at that.  We know enough to be dangerous but not enough to be in charge.  We want to question everything but try not to.  We can tend to be catastrophic thinkers because that is how we are trained to be, but fear being alarmists.  We want our care providers to actually like us, when we know they inwardly cringe knowing ...

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I have the privilege to work in the medical profession where astonishment and revelation awaits me behind each exam room door. In a typical clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient.  I must peel through the layers of a person quickly to find the core of truth about who they are and why ...

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Be obscure clearly. -E. B. White As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process ...

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“Wait until you see what is waiting for you in the next exam room …” My clinic nurse was barely able to contain a smirk.  This meant one thing to a doctor in training:  the next patient must be a “train wreck,” with so many things wrong that I would never get beneath the surface during my brief visit.  I was running 30 minutes behind, so I took a deep breath. As ...

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Aspire to decency. Practice civility toward one another. Admire and emulate ethical behavior wherever you find it. Apply a rigid standard of morality to your lives; and if, periodically, you fail ­ as you surely will,  ­ adjust your lives, not the standards. -Ted Koppel This week started out ordinary enough but took a quick turn when I got a message from the media director at my university that a 14 month ...

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All of us come to the study and practice of medicine through different pathways: some because of family members who were doctors or patients, some out of our own illness or woundedness, some out of intense drive to achieve and serve. I came to medicine because of my grade school classmate Michael. My grade school represented a grand social experiment of the early 1960’s.  It was one of the first schools to ...

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Patients are increasingly demanding, and understandably so, that since they pay for their medical tests, they should receive results directly and immediately without waiting for physician review or interpretation.  Recent articles in the lay press about this issue are accompanied by scores of online patient comments insisting that physician reporting and interpretation is too often unreasonably delayed, often inaccurate, or just plain unhelpful, so why bother waiting at all? Dr. Google ...

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If you want to identify me, ask me not where I live, or what I like to eat, or how I comb my hair, but ask me what I am living for, in detail, ask me what I think is keeping me from living fully for the thing I want to live for. - Thomas Merton As a patient waiting to see my health care provider,  I would adapt Merton’s template ...

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