As Hannah's granddaughter clutched at her skeletal fingers, the blanket fell to the side revealing the faded serial numbers on her forearm. The family gathered, yet again, to say goodbye. This time her acrid breath had lost humidity, her respirations dry and raspy, the extremities mottled with a bluish tinge. Death had visited the neighborhood before. Lounged in the parlor. Nibbled on crackers and tea. But letting go was not so ...

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It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is. Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged ...

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Empathy My eyes glare across the table. I can feel his shoulders hunch forward as he subconsciously recoils in preparation for my response. The room becomes thick. Nurses, social workers, a chaplain. Everyone waiting for the doctor. Not just the doctor, but me. Sixteen years out of residency. Battle-scarred and warn by PTSD. The images from residency still so clear. A gasp, a gurgle, flat line. Wailing family members, angry nurses, and ...

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You've been swindled. At least that's the conclusion I've come to. It wasn't the hucksters or the snake oil salesman. It wasn't big business, big medicine, or some greedy hospital administrator. It was most likely pharma with a large dose of helping from your doctor. Plain and simple. I've learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into doctor ...

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Many years ago, three doctors formed an internal medicine practice and were proud of the thousands of patients they accumulated. They were fine physicians and very dedicated to the masses who walked through their clinic doors.  They saw patients in the office, rounded at two hospitals, and visited a number of nursing homes.  This was truly a full-service practice. Around 2005, Dr. A was starting to fatigue.  He was well into his ...

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I have a confession to make. I don't understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I feel the stress. It's as if someone applied a vice grip to my insides in the middle of medical school, and it has never let up since. The pressure is ...

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I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn't reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let's just say that it has quite a kick. These thoughts jostled through my mind this morning as I pulled into ...

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I have come to believe that humility is an essential component of wisdom. Never have I found this truer than in the practice of medicine. In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble. Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact, the label "difficult" assumes the problem ...

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There are parts of medicine that are horrendous. Moments too painful to recount, and events that will break even the most innocent participants. And then, there is unspeakable magic. I live for the days when a patient comes to the office with a particularly vexing set of symptoms. Specialist after specialist bows their head in disagreement. Laboratory values whisper falsehoods with jeering tongues. Symptoms are transient, physical exam signs inconsistent and in ...

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At first, you'll question reality. You will hear your own words, but they'll sound foreign — apart from you. The ground will still reassuringly push back against your toes when you walk out of the room, but you will wonder if they are your feet. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. It is not the real you. Be assured ...

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His voice was gruff and his expression surly. "I don't want any more medications." His face was indented by deep clefts, remnants of eight decades of life hard lived. His tone was commanding and certain. I knew that he was fond of me, but I could feel his patience slipping. He neither asked about nor accepted his diagnosis of heart failure. I could tell him till I was blue (or he was ...

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It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you'll wonder why you didn't get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you'll let it go and move on. Or so you think. Until during surgery when the scrub nurse ...

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If you are planning on complying with Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), make sure to allot the appropriate time and funding necessary to update/upgrade your practice. Realize that the measures will be arbitrary, the data implementation arduous and the moments for live patient care fleeting. Expect that, no matter how Herculean the task may be, the finish line will move often and unexpectedly. Prepare to get ...

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"Too many times I feel We are losing time once shared And only when you're in ecstasy You seem to really care" I recognize the song immediately — Chuckii Booker's "Turned Away." Not the regular version, but the extended one. As the words rush over me, caressing my nostalgia, a memory, a moment comes back. I was standing behind the counter at Homer's Ice Cream on a brilliant summer morning before the doors opened. We ...

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An excerpt from Five Moments: Short Works of Fiction. “Dad ... you can let go now.” Thomas heard his daughter’s voice from a distance. It awakened him from his reverie. He relived those five moments of life and took their lessons seriously.

  1. Rejoice in the ordinary as if you were a child seeing everything ...

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It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three. Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner ...

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I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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To say that there is no fear in the examining room is an inaccuracy. I'm not only talking patients here. Physicians may harbor just as much worry and discontent. There are the old standbys of course: The swat team of malpractice attorneys lounging in the waiting room ready to pounce or the old demon of misdiagnosis and the consequences that may follow. Few of us talk about that sinking feeling which ...

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There is a basic communication gap between you and me. How could there not be? It's not what you expect. I say you have cancer, or heart failure, or emphysema. Full stop. A conversation ensues. This is not what I'm talking about. It's more like when I report to you a series of normal lab results, and at the end flippantly mention a slight elevation of the white blood cell count. ...

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You won't at first. But then, you will. It will start innocently. Probably even before medical school. You will have a morbid curiosity about passing ambulances and motor vehicle accidents. Your original empathy for the victim will disappear when you begin to think of them as patients ... as test cases. The commodification accelerates during the early years of medical school. Anatomy, pathology and physiology provide you a vocabulary to replace human ...

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