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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How often does this occur?  A patient comes into the hospital with a chronic disease, or two or three.  The patient has worsening of their disease(s) because they have not taken their medicines.  They say that the medications are too expensive, but they have been smoking and/or drinking and/or using cocaine.  Usually they also have a DSM-IV diagnosis or two. You can fill in more information about the patient, unstable social ...

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Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine.  The article has received (as expected) mixed reviews, because the concept causes angst for some physicians. I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system.  Retainer medicine is a response to burnout.  Yes, many retainer physicians are making more money.  Is ...

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Some hospitalists are in denial.  Some hospitalists have become methodologic critics.  But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously.  We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients. This article provides an opportunity, not a scolding:

In an accompanying editorial, two other researchers from the VA Medical Center in ...

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