Since the two very sudden public suicide deaths of Kate Spade and Anthony Bourdain, society has again recognized that we never know what is under the surface of another’s façade. As physicians, these tragic occurrences emphasize that our caregiving requires seeing the entirety of an individual’s many parts. While we acknowledge that the façade is not fake -- it is but one true representation of an individual, well-curated, like pages on ...

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The recent prominence of the #MeToo movement has shined a light at many places in our society where insidious or even obvious sexism against women has long gone unremarked. Even when noticed it’s just shrugged off as the way things are. In honor of this, #MeToo was named Person of the Year for 2017 by Time Magazine. Medicine is no exception to this pervasive problem. A very interesting recent essay in the New ...

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When we think of bullying, we’re usually worrying about our school-age kids or remembering bad experiences from high school. We learn quickly in the health care field that bullies don’t change once they enter the clinical world. Health care, with its incredible differential in knowledge, authority and pay creates large power differentials and easily generates subordinate/superior relationship dynamics. Bullying occurs within professions between trainees and trainers and faculty, and across clinical areas ...

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Altruism is killing us. Take a second to let that sink in. Truly think about it. Resist your conditioning to refute this claim and try to apply it to your life. Still having trouble? Let me try to explain. In order to understand the truly destructive force of altruism on medicine, one must first define altruism. This can be difficult to do in the United States as any “good” or “charitable” ...

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Summer is upon us, and with it comes the end of the academic year, graduations and the arrival of the newest crop of interns. Soon these fresh-faced physicians will enter into one of the most remarkable educational experiences of their medical careers: residency. Many of these soon-to-be-interns are looking to attendings now for advice on how to excel during (or survive through) the arduous first year of training. Suggestions like ...

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It was 5:45 in the morning on a Monday after a full weekend of call. Thoroughly exhausted, I shuffled into the elevator and was met by the stench of stale clothing mixed with cigarette smoke. A painfully thin teenager exited, looking lost. I allowed him to wander out, grateful to be spared his odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have. Morning ...

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For the last 8 years, I have worked as a locum tenens hospitalist. I began on this path when it was the least popular option upon graduation from residency. I did countless hours of research trying to find accurate information about locum tenens companies, but never found anything written by physicians, only by the companies themselves. So, I stepped into this field blindfolded and learned the hard way. Since then, I have ...

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During the 1990s Dr. Jack Kevorkian drove his Volkswagen van through an unmet need in American medicine euthanizing 130 patients who felt death was the only solution to their suffering. He euthanized his "patients" with devices he named the "Thanatron" and the "Mercitron." The former allowed his patients to administer IV barbiturates and potassium while to latter delivered carbon monoxide. When convicted of manslaughter, he told the court, “Dying is ...

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My first patient of the day has metastatic pancreatic cancer. She's had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she's been in and out of the hospital. Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. "Tell her to focus on the positive," they request. I wonder if there ...

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“The worst enemy of a doctor is another doctor,” said one of my professors during rounds when I was doing my internal medicine clerkship as a third-year medical student. I remained skeptical. That did not match the idea of becoming a doctor nor did it support what Dr. Pellegrini said: "Medicine is the most humane of the sciences." Nonetheless, my old professor explained that when it comes to patient care planning and ...

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