The nation’s racial upheaval, particularly vis a vis law enforcement, has shown us the value of the skill of de-escalation. A situation arises, and several outcomes are possible, although some are clearly preferred. The specific technique and approach utilized may determine the end result. A range of options is often available. What can make these situations so difficult to unravel afterward is that an option that may lead to escalation may ...

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Some time ago, I performed a colonoscopy on a patient who was having serious internal bleeding.  He had already received multiple transfusions since he was admitted to the hospital.  After obtaining informed consent for the procedure, I performed the colon exam.   I encountered blood throughout the entire colon, but saw no definite bleeding site, raising the possibility that the source of blood might be higher up than the colon, such as ...

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We’ve all heard about the blue wall of silence that describes a belief that law enforcement personnel will refrain from reporting misconduct of their colleagues to the proper authorities. Physicians had similarly been accused of hiding behind a white coat wall of silence, as I have written previously. This describes the belief that physicians do not reliably turn in colleagues who are incompetent and impaired. Personally, I ...

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I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog. While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises. Of course, EMR has brought tremendous advantages to the medical profession, and we are all grateful for the technology. But this progress has exacted a cost. Many of them are clumsy ...

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Future doctors will celebrate that they no longer prescribe the same drug at the same dosage for hypertension or pneumonia or arthritis or cancer or many other conditions. Who knows even if drugs will be the mainstay of medical treatment. Tomorrow’s treatments will be tailored to one’s age, gender, weight, race, overall medical condition, severity of the medical threat, and genetic profile, among other variables. We don't all wear the ...

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Physicians handle thousands of questions annually. We respond to inquiries from patients, their families, insurance companies, nurses, professional colleagues, pharmacies, pharmaceutical representatives, our staff, and even strangers. This is, of course, a part of our job, and it consumes a substantial amount of our time and energy. And, responding to questions is not as easy as you may think. Words matter, and a clumsy choice or omission can wound instead of ...

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At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their ...

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Doctors dispense medical advice. That’s what we do. Folks come to our office with various medical issues. We talk to them. We poke around some of their body parts. Then, we exercise our medical judgment. We might order a CT scan. We might prescribe stuff. We might simply reassure them and send them on their way. This is a typical day in the life of a health care provider, formerly known ...

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Medicine is for the birds, or it should be.  Hear me out.

A day before I wrote this, I was on the trail in northwest Ohio, binoculars in hand, trying to tell one warbler from another.  This was the final weekend of the biggest week of birding in Magee Marsh on the shore of Lake Erie.  Birders converged here from neighboring states and even from foreign countries ...

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We live in an era where plastic surgery is routine.   Indeed, in many parts of the country, plastic surgery is an expected rite of passage.   Years ago, facelifts and "tummy tucks" were done on those in middle age who were trying to experience a surgical time machine.  Now, folks in their 20s are having all kinds of work done, not to recreate a prior image, but to create a new ...

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In our office, sometimes our secretaries listen to background music. A few days ago, while walking through the office, I heard an iconic song, written and performed by a songwriting legend. Even someone like me, who was never deep into the music scene, automatically recognized the song. I asked our receptionist, a young lady in her 20s, if she knew the song that was playing. She didn’t. I identified the ...

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From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label "toxins" already suggests that these are noxious agents. If one accepts this premise, it is entirely ...

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Physicians and nurses deal with the deepest issues of the human condition: life and death. Our profession brings new life into the world and does our best to bring comfort and peace at the journey’s end. It is a profound and emotional experience for medical professionals to be with a patient and family when life ends. There are other professions who routinely confront loss of life. Law enforcement personnel, paramedics, firefighters, ...

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I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through. It is an easy task to miss the diagnosis. Every physician has done this. The diagnosis can be ...

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Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely. The medical universe ...

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It may seem odd that a gastroenterologist patronizes fast food establishments several times each week. I’m in one right now as I write this. I eschew the food items –though French fries will forever tempt me – and opt for a large-sized beverage. In truth, I am not primarily there for a thirst-quenching experience, but more to ‘rent a table’ so I can bury myself in some reading. Indeed, many ...

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From time to time, I am asked by someone about participating in a medical research study.  These situations are usually when an individual, or someone close to them, has unmet medical needs.  Understandably, a patient with a condition who is not improving on standard treatment, would be amenable to participating in a clinical trial to receive experimental treatment. I find that most folks misunderstand and exaggerate the benefits they may receive ...

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When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand. Of course, if you come to see me with a stomach ache, at some point, I will direct the dialogue toward your abdomen. Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes. Why does this happen? First, I enjoy it; and secondly, ...

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I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.  Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.  Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.  But, keep in mind that these systems were not devised and implemented because physicians demanded them.  To the contrary, ...

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Exercising good judgment can mean the difference between life or death. Life can be unforgiving of the choices we make. As we all know, many life events are beyond our control and understanding. But, there is much we can do to shape our paths to a brighter destination. Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?

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