I had a nice conversation with a dermatologist at a party recently.  He started complaining about the notes he receives from other physicians.  He used terms like piles and piles of junk. Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system. Several years ago I ranted about the necessity ...

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I recently tweeted about Danielle Ofri’s important piece, The Doctor Will See Your Electronic Medical Record Now.  I like the piece, and especially like some of the quotes, but still I believe the problem needs an expanded take. Context represents the major advantage of 38 years experience as a physician.  Over time, one sees trends come and go.  Hopefully one can see the strengths of the “good old days” and ...

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Attending physicians have great responsibility. We have ultimate responsibility for patient care and for medical education. Medical education involves sharing facts, the thought process and bedside manner. Recently we had a “frequent flyer” admission. For a few years, the housestaff labelled this patient as non-compliant – and even wrote it in his chart. He is young (less than 30) and has a chronic disease. He had multiple admissions and often left ...

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The Wall Street Journal has a question that I cannot really answer in their article, Nurse Practitioners and Primary Care. This question has an implicit assumption that primary care is one thing, and that that thing is relatively straightforward and simple. I have written about this problem incessantly for the past 11 years on this blog. The term primary care has become the equivalent of a Rorshach test. When we ...

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I still think that the third year of medical school serves a wonderful purpose. I never learned more during my entire school experience (perhaps I learned more as an intern, but that is post-graduate). Danielle Ofri writes through darkened lenses: The Darkest Year of Medical School. So for the non-physician readers let me give my opinions on the third year of medical school. After two years of mostly classroom experiences, our ...

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Once upon a time (actually when I did my residency), we worked long hours, were taught well and learned from our patients. Residency training had minimal rules. When we looked for a residency we took work load into consideration. Some residencies were more challenging than others. I choose a busy residency because I thought (back then) that I needed to see sufficient numbers of patients to become a good internist. Our ...

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Why do we never consider unintended consequences? Whether we are thinking of legislation or physician led guideline panels, or governing bodies (like ACGME), the lack of consideration of unintended consequences remains mind numbing. Let me provide some examples. Please read this articles about how the war on drugs has fueled the hepatitis C epidemic. One could also argue that this war damages more young people than the drugs themselves. Many illicit ...

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Recent research suggests that medical students lose empathy during the third (the main clinical year) of school. Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently. Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to ...

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Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external transformation of our wonderful profession. We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and ...

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American Medical News has an important article - Will a “silent exodus” from medicine worsen doctor shortage?

Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see. Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors ...

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