"I have a riddle," Paul says, as the dining room falls silent. "You're at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There's a room upstairs with three lamps, labeled X, Y, and Z. You can turn on and off as many switches as you want while you're downstairs, but you can only go upstairs once. And once you're upstairs, you ...

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Not long ago our emergency department got a call from the health department informing us that we had exceeded our stool limit. Not quite sure how this was measured, who sets the limits, or even why such a call would be necessary, but I do know that once again we have seen a lot of stomach flu running around. Unfortunately, we can’t just tell patients to stop pooping, so I’m ...

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 Working in urgent care, I've started supervising some of the other providers at sites other than my own -- 19 sites in all in Pennsylvania and Delaware -- so I hear about a lot of patient situations.

The urgent care site where I work is in an affluent area.  Most of our patients are employed or retired and have health insurance, though I have certainly encountered a number of patients ...

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I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia.  He cut his head in a fall, suffering the ravages of gravity as so many do every day, every night. He was Caucasian.  His full-time care-giver was African-American.  That young man was the only person who could calm the angry, profane mood swings of his increasingly difficult, neurologically ...

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As I saw the fellow purposely manipulate her fractured ankle, I knew I was wrong in not stopping him. Three hours earlier, Mr. Sanchez*, a past boxer, and soccer player, came in with a broken pinky. He was moving from Atlanta to Houston, and in the process of moving boxes, a rock smashed his finger against something. Odd story, but he was the nicest patient I ever talked to up to ...

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Being a physician is an important role. It's easy to forget the impact that you have on a patient just by being at their bedside. It's huge. Have you ever been a patient? It's an incredibly vulnerable experience. You're not really sure what's happening and what is going to happen next. People are really putting their faith in you to understand their needs and to ease their suffering. It's a powerful thing to ease ...

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“Are you serious! What are you doing to my son! How can you have him tied to the bed like this!” Michael’s* mother was irate and yelling at my resident as I stood at the back of the room. Michael had HIV/AIDS with a CD4 count of 20. Hours before, he had bit his mom on the hand, leaving visible bite marks. As his mom continued to scold my resident, my ...

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As a relatively healthy Medicare patient, I do not visit doctors often. I have had digestive issues most of my life — probably from too many antibiotics when I was a child with recurring strep throat, or so I'm told. My husband and I had just returned from living out of state for two months while he was treated with proton therapy for cancer. My stress levels were high. I was not resting well ...

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Soon after match day, I became concerned. I knew I was going into emergency medicine. However, I felt unprepared to manage a clinical encounter with limited time and incomplete information. At the time I entered residency, the only published guides available on “how to be an intern” reviewed the medicine I already knew. The only books available on decision-making included statistics, which I knew wouldn’t be immediately useful in a ...

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A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do ...

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Antibiotics are ubiquitous in today’s society. Prescriptions for these bacterial killers have become so prevalent that a wonder drug cure phenomenon for any illness has become the cultural norm. The evidence is overwhelming that antibiotics are far too overprescribed for viral illnesses. They are 100 percent ineffective against viruses. And the number of inappropriate antibiotics prescribed has been increasing for decades, as high as 30 percent in one study. For years, ...

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I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room. I take a couple of bites and can already feel acid rising ...

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One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as "the regulars," these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get ...

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I sometimes work as a church security volunteer.  And when I do it, I get to simply stand and watch.  Watch for someone sick or injured (we have defibrillators and wound care equipment).  Watch for someone coming to cause harm.  Watch in order to call the police.  Watch to keep the children safe. And it occurs to me, when I do it, that watching is incredibly important.  I know this as ...

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I carry you in my heart. Not your cold and quiet and still little body.  No. I carry the you that I never knew. The you that your parents grieve. The you that will never grow up. The you that laughed and played that nobody new will ever meet again. I carry you in my heart. It was that you that made me grit my teeth when I heard they were bringing your body ...

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The recent pardon of a convicted child rapist by the ex-Kentucky Governor has sparked a lot of controversies. The basis of the pardon was- “the victim’s hymen was noted to be physically intact.” Evolving studies have continuously shown that the hymen is not a reliable or accurate means to conclude sexual assault. But if physical damage is the only criterion used to assess ...

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I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think. Years ago, when I declared I was going into emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.” She was politely dismissive ...

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I'm an ER doc, and I spent my last two decades in the house of medicine. First, training to become a doctor. Then, trying to be a better doctor. No matter how hard I tried, I've never been the "perfect doctor." I started wondering: what makes one a "perfect doctor"? The perfect doctor lives in the moment, focusing on the here and now: This patient. This case. This encounter. They devote ...

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I overheard a disappointing phone call while supervising a radiology resident recently. I could tell that the resident was struggling in a conversation with an emergency department physician, so I asked him to switch over to speakerphone. Eventually, I heard the emergency physician say, "Listen. This is how it works. A patient points to what hurts. Then I have that part scanned, and you tell me what is wrong." Disheartening as ...

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Having recently testified in several legal cases involving strangulation, here are some facts we all need to know about this extreme form of domestic violence (DV). I invite other subject matter experts to share their personal opinions on what is important. 1. Strangulation is assault with a deadly weapon - an act with known potential lethal consequences. Formally defined, strangulation is an external force applied to the neck cutting off blood ...

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