I was struck by the difference between my care and that of the rest of the system as I cared for a patient recently. She was complaining of a strange pulsating noise in her ear that had started a few weeks before. We chatted for a while, as I asked about any sinus symptoms: If she’d ever had anything else going on like this, what other significant symptoms she was ...

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That statement from a recent patient was a summary to me of what is bad in our health care “system.”  It’s a terrible summary of what is seen all over this country with people who must make the choice between financial solvency and health. Here’s what happened:  It was a new patient I saw, who is a veteran who owns two businesses.  He went out on his own when he “kept ...

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I have good days and bad.  Some days I am content, connected, focused, and motivated.  On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions. On other days, not so much.  I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn't leave me alone.  I keep score of all the ways in which life ...

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I really like Van Morrison.  If I need to be lifted up on a Friday afternoon I'll play a greatest hits album and will quickly be smiling.  One of my favorite songs is Days Like This. You would expect when someone says "there will be days like this," they are complaining about days when everything goes wrong and you just have to endure to the end, hoping that "the sun comes up ...

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I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul ...

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Hi, I’m Rob.  I’m a recovering doctor. Yeah, I know I used that line once before, but it’s a special day for me today.  Humor me.  Five years ago today I earned my last money from an insurance company.  Yep, today is my five-year sobriety date. Five years. That was before the Affordable Care Act, before the Cubs won the World Series.  Before anyone knelt for the national anthem, and ...

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The consultant note read:

Weight 250 lbs. BMI 40.3.  Patient is morbidly obese.  Counseled on the dangers of excess weight.  Counseled to increase exercise and decrease calories.
I walked into her room.  She smiled at me as I walked in, a lovely smile that reached her eyes.  I scanned her record.  She was in my office for an ankle injury.  Blood pressure normal.  Weight 248 lbs., BMI 40. When I looked back at ...

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"Wait. When did you say you started that medication?" "Two weeks ago." "And when did you say you started having those symptoms?" "Uh ... about ... let me think ... it was — two weeks ago." This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have ...

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I was really anxious.  My father's legs were getting weaker and his pain was worsening.  He had been having pain for quite a while, and that pain was often disabling in its severity, but the weakness was alarming. Dad went to the neurosurgeon, who was also alarmed at the weakness, but didn't feel that the problem was surgical in nature.  When I heard this I broke one of my most tightly-held ...

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Taxes. Doing taxes feels like a financial rectal exam.  I hate doing taxes.  Yeah, I don't like getting rectal exams either. It's not that I resent paying the government for the fine services they render and the high quality of elected officials we have. It's not the existence of taxes I hate; it's just doing taxes make me feel extremely insecure.  Sharing my personal and business finances with my accountant and the ...

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