Clinician educators have the opportunity and responsibility to influence students, interns and residents.  While we can have some hubris in our education skills, we must always demonstrate humility in our patient care role modeling. Dr. Orhan Muren, one of my early role models, often told us to never be “cocky” when taking care of patients.  As I recall his admonition, I realize that he was urging us to have true humility. But ...

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During my training in the 70s, heroin use dominated our substance abuse horizon.  We saw many patients with IV drug-related complications.  We saw heroin overdoses. For the next 30+ years, we rarely heard about heroin.  Over the past 10 years we have seen increasing opiate abuse, but the opiates came from prescriptions.  Over the past 2 years, heroin has once again reared its ugly head. This article blames physicians for opiate addiction: ...

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Recently, I spent two days in Greenville, SC as a guest lecturer. During that trip, I had time to chat with some hospitalists. During our conversations, I explored a classic problem: the inpatient-outpatient handoff. Talk with hospitalists and you will discover their angst about getting outpatient information on their admitted patients. Talk with primary care physicians and they echo the angst when seeing recently discharged patients. Personally, I have experienced both sides of ...

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The transition between the basic science years and the clinical years in medical school are jarring, mystifying, exhilarating and thought-provoking. Recently, I did an hour conference with approximately 30 medical students. About half started their clinical year five weeks ago, while the remainder have only three weeks left before they finish the year. They gave me permission to share our discussion. We focused on their (and my) observations about the ...

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Who can argue against evidence-based medicine? Who can argue with using evidence to develop guidelines? The key to practicing great medicine must involve using the best evidence to guide our protocols. My son, while in college, was an English major. I remember reading his papers. He often used the phrase “on further reflection.” I often recall that phrase when considering these complex issues. Frederick Nietzsche wrote, “There are not data, only interpretations.” ...

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Now that we no longer have to worry about the SGR, we have a new worry. The law consolidates several measurement tools into one big tool. CMS has declared that it wants to pay for value. The law provides a blueprint for paying for value. The underlying assumption of this approach is that we can define and measure value through measuring quality components. Can we define health care value through measurement? ...

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Many readers know that I favor empiric antibiotic treatment for adolescent/young adult pharyngitis when the clinical signs and symptoms strongly suggest a bacterial infection. I favor narrow target antibiotics and only in the patients with Centor scores of 3 or 4 (and perhaps some 2s when the patient looks very ill). This would exclude over 50 percent of patients from antibiotics. Most organisms already have developed resistance to penicillin, amoxicillin, and ...

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Dr. Wes has written passionately against MOC: ABIM Pleads for Mercy.

But perhaps we should ask first: Why MOC at all? Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM’s website, might MOC have really been created because the ABIM’s consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% ...

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Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

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All physicians know the scenario. You want to reassure the patient; the patient wants another (usually expensive) test. In our new metric age, we may have a conflict between overuse and patient satisfaction. The article provides some hospitalist data: "Hospitalists know guidelines but overuse tests to reassure selves, patients." How do we balance making our best evidence-based decisions with patient demands? Some experts will tell us that we really have a communication ...

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