When I was a medical student, I worked with an non-government organization (NGO) in Rwanda to provide medical care to women with HIV. Nearly all had witnessed their family members murdered during the genocide, and many became afflicted with HIV as a result of rape. Our initial focus was on getting antiretroviral therapy to these women, but we quickly realized that while it was important for them to have access ...

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As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me. Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: ...

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One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community centers. What ...

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Our health care system is broken and in dire need of reform. We all know the statistics: the U.S. spends $2.7 trillion on healthcare30% of which is waste in the form of unnecessary tests and unnecessary treatments. Conflicts of interest are rampant, with 94% of doctors reporting an affiliation with a pharmaceutical or device manufacturing company, and many more insidious influences including salaries being tied to productivity. Dozens of studies have shown ...

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In a recent blog post, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing. So what can you do to ensure that you obtain just the right amount of care? It isn’t easy -- if it were, if there an algorithm that would give ...

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It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis. I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked. My mind went blank. “Uh, I’m not sure,” I said. “Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the ...

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Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to? At the moment, there is very little information for you to make such a decision. Many people will choose ...

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On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections. 1. "You were terrified of being a doctor!" I mentioned this article to the attending who oversaw my first shift as ...

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Hospitals can save you, but they can also harm you. So how can you stay safe in hospitals? Follow these 12 life-saving tips: 1. Never go alone. Always bring someone else—a trusted family member or friend—with you. That person will be your primary advocate, and can serve as an extra set of eyes and ears to help make sure you are safe. (This tip applies to routine doctors’ appointments too; always ...

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chinese healthcare Wang Li is a 48-year old farmer from Dalian, China. After a two-day trip to the major provincial hospital, he’s heading home to his village to die. Wang has lung cancer, and even with insurance, his surgery will cost him 20,000RMB—$3,000, which is twice his annual salary. The surgery would be curative, but it doesn’t matter. “I cannot burden my family,” he said. I am a Chinese-born, American ...

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Everyone knows that life in the ER is fast-faced, extremely busy, and ever-challenging. When things get crazy, it becomes habit for busy physicians to see patients as “the chest pain in room 6” or “the broken wrist in the hallway.” We turn people with their amazing lives and fascinating stories into a nameless number and a “chief complaint”. It’s a practice that’s easy to justify—after all, taking a long ...

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An excerpt from When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. One Friday, Jerry got the scare of his life. Jerry is a 48-year old mechanic who is in good health. His ...

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Have you ever gone to the doctor and felt like he wasn't listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place? Studies show that
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An excerpt from When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a ...

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May is a recent divorcee in her early sixties. She was working out at the gym when she began to feel queasy and lightheaded. She awoke in the back of an ambulance, and soon, she was in an ER getting blood drawn. “We need to make sure you don’t have a heart attack,” she was told. As the day went on, May underwent test after test to “rule out” ...

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I recently a session at the Asian American Women Leadership Conference to high school and college students about taking care of our bodies. One the topics is common health myths. Despite our best efforts at debunking them, here are 8 pervasive myths: 1. You can catch a cold from being too cold. Growing up, how many of us have heard this from well-meaning parents and grandparents? It’s easy to see how ...

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In a recent post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care. Here are ...

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Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the ER, he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his ...

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Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with ...

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As emergency physicians who are trained in acute resuscitation and thrive in high-stress situations, we tend to roll our eyes at the less acute complaints our patients come in with. “Back pain for three months? Headache for a week? Why are they here now?” Patients, too, complain about this. “Can’t they see it’s not a real emergency and go see their primary care doctor? This must be costing our healthcare system ...

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