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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One of my many mentors died recently: Will Deal, former dean of UAB School of Medicine, passes away at 76. I had seen him 6 days before at a restaurant – he seemed in perfect health.  We made lunch plans. As I have thought about Will over the past 4 days, I thought about mentoring, because he mentored so many people.   I thought about intern applicants who ask about ...

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A reader sent me this question: "Yesterday, after my MCAT class, two biomedical engineering students and I talked about this article and the future of medicine. We debated whether such robots could reduce the need for doctors by 80%." When I read such predictions I chuckle at the naivety of those who make such pronouncements. The computer advocates do not really understand medical care and diagnosis. What do we do that computers/robots ...

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You have to forgive me, it's not me, it's my mind, it's very slow, and I have to pin everything down. -Lieutenant Columbo With his rumpled raincoat, ever-present cigar, bumbling demeanor and Sherlock Holmesian powers of deduction, disarmingly polite homicide detective Lieutenant Columbo took on some of the most cunning murderers in Los Angeles  most of whom made one ...

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Physician a burnout has great current interest.  Many authors are worrying about burnout and therefore writing about this problem. What are the common root causes of burnout?  Primarily burnout comes from loss of control and overwhelming undesirable activities. Burnout occurs when the job becomes overwhelming. Burnout likely is increasing because many physicians feel that they do not control their lives.  Too often the current finances of medicine "force" physicians to spend inadequate time ...

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The New York Times recently had an important and provocative piece, "Overtreatment Is Taking a Harmful Toll." The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much. The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems. Let ...

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Our educational system rewards zebra finding more than conserving financial resources.  Too many academicians think zebras first and then default back to the obvious diagnosis. One problem stems from our educational process being haphazard.  Rarely do we select attending physicians for teaching skills, or teaching philosophy.  We get faculty generally from three buckets:

  1. Research future: Can they get grants funded and produce important research?
  2. Clinical expertise: Will they attract complex patients to the ...

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Too often I see both generalist physicians and subspecialists failing to fall back on the basic principles of a careful history and physical and then understand what specific tests to order. One can blame academe somewhat.  Too many subspecialty consults in academic centers end with a laundry list of tests, excluding almost anything that could ever be part of the differential diagnosis. One can blame the payment system.  The generalist physician, rather ...

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