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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