One day, I was full of moderate despair, overworked, befuddled by the EHR with a tinge of burnout, staring at my computer, I treated myself to something I’ve not done before. It was my 62nd birthday that day, and I gave myself a birthday present. Before rising from that swivel chair, I had written down on a sticky pad the day that would be my retirement date, exactly one year ...

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Too often, residents want you to address something, so they don't have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID. For me, one example seemed rather routine: a diabetic with another medical illness. It wasn't terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady ...

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From the earliest days on the clinical wards, everyone probably worked with a senior physician who knew how to game the system. It might be doing a rigid sigmoidoscopy on admission for every patient who had a rectum — something not the standard of care forty years ago. Or maybe it was accepting a pharmaceutical company subsidized tax-deductible junket under the guise of CME at a place with sparkling white ...

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Maybe 10 to 15 years ago, my medical center at the time invited a prominent former resident to give grand rounds. He had become the statistical director for what was a large regional insurer absorbed by a national insurer shortly after that. He spoke very little about the prevalence of disease among his company’s beneficiaries but extensively about how his company assessed the performance of physicians. He also related how ...

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One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, ...

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There was a time within my professional lifetime when old records would arrive on the medical ward in a wheeled wire basket, multiple volumes with shabby pages. And in the VA of the 1980s, which still had veterans of World War I who never lived anywhere else the previous half century, the forklift could deliver not only the charts but the x-ray films that had not yet been sent to ...

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