Doctors by our nature do not handle idleness well. We value our vacations, of course. I never sought out a study to see if doctors vacationed differently than others. Some probably hang out someplace warm, others seek out the best eats of the place they are visiting, some cannot wait for the cruise ship to dock so they can disembark for a tour of a new place. Vacations, though, are ...

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Six months have elapsed since exiting the pageant of my hospital via retirement.  Like many people who devote countless hours to professional activities, some mandated, some by compulsion to detail, this windfall of unstructured time, no matter how well planned, can prove disorienting.  My final destination was a small inner-city hospital, preceded by twenty years affiliation with an enormous comprehensive regional center.  The people there, near where I live, have ...

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As each calendar year closes, organizations compile best/worst lists: TV shows, movies, exceptional people that bring character or immortality to our year as it fades into history. Medicine has its heroes and scoundrels. I would expect that all physicians can instantly name five teachers who shaped them and five guys they scored as real zeros on their evaluation forms. For the benefactors, we not only gave them higher scores but assimilated ...

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Retirement has gotten me edgy. Three months after departing, I had begun spending too much time horizontal, which I forced myself to remedy but then finding myself with nothing to do. Moreover, things have gotten more noticeably like Bowling Alone, an often-cited book by Robert Putnam published in 2000 that describes attrition of diverse communal activities over the previous 30 years. For physicians, our daily activities prevent us from working in ...

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My medical center recently cemented an agreement with the Veterans Administration to offer care to veterans who could not be accommodated at the VA. We need paying patients, they need doctors of our caliber — establishing mutual benefit. Military veterans have always been among our patients. During my professional lifetime that has included men of my father's generation whose young adult years encompassed World War II’s widespread draft. World War ...

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Just over a month has elapsed since my retirement from patient care. I’ve been to one grand rounds at my prior medical center, encountering a smattering of old friends, some preceding me to retirement, others in active discussions with their financial advisers and others a mixed multitude of residents and students assigned to the secondary campus that month looking upon us geezers in the small video access conference room with ...

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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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