We all know that there’s a remarkable shortage of physicians in America and that it’s growing worse.  This is especially true in primary care but it’s present across all specialties.  This shortage alone is a significant stress on practicing physicians.  But when it is coupled with corporatization, the increasing complexity of medical care, unrelenting electronic charting requirements and the explosion of administrative tasks, physicians barely keep up each day. This is one of the ...

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Several years ago, a group of us concerned about health care costs and outcomes met with some local HR benefit managers. One was the head HR person of a city. In part of the conversation, she raved about a local chain of urgent care centers. She loved the fact that she could go to one after work to get her steroid shot for her colds. I had enough experience dealing ...

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Compassion. Empathy. These are some of the words commonly thrown around in medical school and residency training. If you ask most medical students why they chose medicine, they will respond with something like this: “ I love to help people,” or “I want to save a life.” I remembered when I entered medical school, one of my professors said, “In order to be good a doctor, you must be compassionate and ...

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It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examining her wound, which had been worsening, I asked her what her A1c number is. She wondered what an A1c number was, and I explained that ...

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Yes, this is a piece on observation medicine as the expansion of our specialty.  My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed.  I learned to stabilize, evaluate and treat then admit or discharge.  Clearly, I’m simplifying though, historically, our disposition decision was binary, patient in or out. Then overtime as I practiced emergency medicine (EM) ...

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I have worked most of the last 20 Halloweens in the pediatric emergency department (ED), so I’ve seen how a split second can ruin your child’s holiday.  Here are some things you can do to plan ahead and avoid the ED. 1. Avoid trip hazards It’s a recipe for mishap. Your child is in a costume that may have long hems or unusual shoes or a mask limiting their normal vision. A ...

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"Passion isn't a path in the woods. It is the woods." -Tom Robbins, "Half Asleep in Frog Pajamas" I've met plenty of accidental physicians. These have been photographers, travel writers, artists, outdoor guides and chefs who awoke one day to find themselves doctoring. Their passions didn't die — they were just delayed by lifestyle choices. By the time they recognized a need to follow their passion, they were at least partially through ...

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I don’t miss making the phone calls in the middle of the night. “Hi, this is Dr. Yang calling from the psychiatric emergency service. May I speak to Mr. or Mrs. Doe?” “Yeah, this is Mr. Doe,” he’d reply, his voice thick and slow with sleep. “I’m sorry to call so late. Your son is here at the hospital.” Take a breath and slow down for the next part. “He’s alive and doing OK at ...

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I spent the summer between the first and second years of medical school in the emergency department at Cincinnati’s major trauma hospital. More specifically, I spent summer nights there, studying the effects of interpersonal violence. Cincinnati is both a friendly city and a violent city. People say “Hello” when you pass in a corridor. At first, coming from Boston, this mid-West style of friendliness took me aback. At the same ...

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School is back in full swing.  The kids are packed up, scheduled and loaded with notebooks, pens, pencils, computers, and calculators.  Long lines form outside school drop-off areas.  Tired, pajama-clad parents drop off bleary-eyed children, accustomed to sleeping and playing all day, now headed off to fill their little brains with knowledge. Of course, it isn’t just the little ones.  All of our children were home over the Summer.  Now our daughter is a high school ...

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