“Can we please try to be objective about this!” I said these words to myself over and over during this year’s interview season as we formulated our residency rank list. At my institution, the residents and faculty have equal sway in forming the rank list. The chief resident facilitates the resident half of the process. As the hours wore on during our last meeting, the discussion gradually deviated from assessing the ...

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Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely. The medical universe ...

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The doctor opened the door after a gentle knock. He was greeted with warmth, offered a seat by Mary, and promptly sat down on the end of the hospital bed. As he sat, the family stood to greet him. They discussed the grandkids, the trips taken since they last saw each other. The room felt peaceful. Time slowed down. Walking in behind my attending, I had been ruminating about the lengthy patient list, the work to be done. Then ...

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Last June, I became a freshly-minted young doctor, bright-eyed, and enthusiastic about heading off to my dream residency program. By August, I found myself crossing the street on my way home, wondering if I had made a horrible mistake that could have harmed a patient. The most painful thing was, I hardly had the energy to care. This is not why I chose to dedicate myself to medicine. Like many medical trainees, ...

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Residency application season has begun! When I was applying last year, I spent a lot of time thinking not just about what programs I wanted to go to, where I wanted to live and how best to answer "Where do you see yourself in five years?" — but also trying to develop a method for making this decision. This is the mental model I came up with that helped me through ...

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It’s fascinating — the strange clarity that a little panic brings. I remember thinking this in the days after, startled at the level of detail in my memories of the first time I watched a patient die. “Just got a call, transport’s bringing in a code. You good to standby for compressions?” I nodded as I felt my stomach free fall ten-thousand feet, managing a, “Yeah, totally,” that sounded more confident than I ...

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Dorothy Twigg was living on her own, cooking and walking without help until a dizzy spell landed her in the emergency room. She spent three days confined to a hospital bed, allowed to get up only to use a bedside commode. Twigg, who was in her 80s, was livid about being stuck in a bed with side rails and a motion sensor alarm, according to her cousin and caretaker, Melissa ...

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Today, I’m thinking about the end of residency. But first, let me tell you about the beginning of residency. My first day of clinic, my very first week of residency, I had a grand total of one patient scheduled. A seasoned, outgoing resident had given me sign-out on this person, along with some big, knowledgeable shoes to fill. I did my most thorough pre-rounding the evening before. I prepped my note and ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Of all medical specialties, perhaps the most difficult to understand is internal medicine. While the name suggests that those who practice internal medicine focus primarily on non-dermatologic diseases of “Internal” organ systems (which in many ways is true), unlike other medical fields whose names ...

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Pain and suffering together is a universal language. It is unspoken, one that a person of any age feels when they see a loved one die, or when someone sees another human being suffer when nothing more medically can be done. I once saw a Vietnam War veteran who, within a few years of returning home, suffered from a hemorrhagic stroke. He was robbed of his ability to walk, to talk, ...

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A featured article titled "Death by A Thousand Clicks" addressed some of the serious problems and challenges we still face in the "digitization" of health care. As an early adopter of EHR since 2003 and a self-avowed "techie," I can vouch for the fact that many of the government initiatives in HIT, like "meaningful use," actually made many EHRs worse. Why? Because many of the regulations were being written by ...

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Why does the most expensive health care system on the planet do such a poor job protecting the lives of pregnant women? More important, what can be done about it? The United States continues to lead the world in health care spending yet it has the highest maternal death rate among wealthy nations. Researchers have found that maternal mortality in the United States 
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Is your patient having trouble breathing? I can ask respiratory to give him a nebulizer. I'm looking at his chest X-ray now — why don't we bump up that Lasix, too? I wish the ER would have grabbed an ultrasound of that swollen leg. Does he need more oxygen? If something is missing from this picture, it isn't the clinical people who are at fault. Clinicians solve problems with the tools they're ...

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When Ashley Pintos went to the emergency room of St. Joseph Medical Center in Tacoma, Wash., in 2016, with a sharp pain in her abdomen and no insurance, a representative demanded a $500 deposit before treating her. “She said, ‘Do you have $200?’ I said no,” recalled Pintos, who then earned less than $30,000 at a company that made holsters for police. “She said, ‘Do you have $100?’ They were not ...

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Victor Frankl is an Austrian neurologist, psychiatrist, and Holocaust survivor, who survived three years in the concentration camps of Dachau and Auschwitz. He once told a story about a woman, his patient, who called him in the middle of the night saying that she wants to commit suicide. Viktor Frankl kept her on the phone, giving her many reasons to keep on living, until she promised not to take her life. ...

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It may seem odd that a gastroenterologist patronizes fast food establishments several times each week. I’m in one right now as I write this. I eschew the food items –though French fries will forever tempt me – and opt for a large-sized beverage. In truth, I am not primarily there for a thirst-quenching experience, but more to ‘rent a table’ so I can bury myself in some reading. Indeed, many ...

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I'm fascinated by the human body — the intricacies of it, the poetry of it. I am intrigued that a cell can come together with other cells to form tissues, those tissues, organs, and systems. The body is a powerful metaphor for unity: what happens when the one becomes the many, and the many, even more. It is a lesson in both individuality and community; how one sets out to create ...

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This past August, I attended the American College of Obstetricians and Gynecologists (ACOG) District VI meeting in Wisconsin. The theme of this year's meeting was "Bringing it Back Home," with a keynote presentation focused on developing the emotional habits to influence others and "embody the inner attitude of a leader." After a day of much self-reflection, I decided to stop by the poster presentations during a break between the major talks. ...

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Physicians nearing the end of their careers often mourn the loss of the hospital as it once was -- the undisputed center of the health care universe. They remember a time when every community doctor rounded on patients in the morning, and every surgery was performed in one of the hospital’s main operating rooms.

Times, like hospitals, have changed. This article looks at how the changing role of the American ...

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In the recent book, Range: Why Generalists Triumph in a Specialized World, David Epstein makes a strong argument for exploring or sampling different interests and jobs before settling on a career of choice, a process that leads to “match quality,” which describes the degree of fit between one’s work and who they are. This idea flies in the face of our strongly held belief that early specialization, or ...

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