“Planned death.” When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery. When necessary, we prognosticate. But ...

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"The Big Sick" is an intimidating name for a movie. I never know what to think when "sick" is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn't give you much insight, neither does the beginning of the film. It has nothing to do with illness. It's about a Pakistani standup comedian/Uber driver who starts dating a white girl, but ...

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"What's the most common missed fracture?" my supervising PA asked during my clinical rotation in the emergency department. "The second one," I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions. Unfortunately, I didn't always know ...

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Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results. The survival strategies of the interns in ...

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In May 2019, headlines of a study out of University of Michigan hit the lay media: “New Doctors’ DNA Ages 6 Times Faster Than Normal in First Year.”  Using DNA samples submitted by medical residents across the country, the Intern Health Study measured telomere length before and after residents completed their intern years. Loss of telomere length has been associated with morbidity, mortality, and even depression. A ...

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As a community of physicians, I'm sure we have heard the phrase, "I just want to get well, doc," from our patients. Have you ever wondered what does "get well" really mean to them? As a third-year internal medicine resident, I had an unforgettable experience during my intensive care unit rotation. He was an elderly patient with HIV, stage 4 colon cancer with metastasis throughout the abdomen, who was being treated ...

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The EMR has become a focal point in the physician burnout discussion. Although I believe EMRs are a necessary evil, current iterations of them are just not good. Each click on a mouse is a prick on the many good souls that figuratively bleed until they are physically and mentally burned out. Scribes are not a solution either. That is just a workaround. EMRs are one of many things that ...

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It is no secret that health care providers shoulder a lot of responsibility. As a whole, they take this on with both competence and kindness. Sacrificially, they go above and beyond in order to provide patients with the highest of quality care. They juggle a multitude of professional and personal responsibilities in creative and admirable ways. Meanwhile, each health care provider learns to adopt a unique combination of coping mechanisms ...

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Although pediatric (children's) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery. The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children's hospitals "are the backbone ...

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Our job as health care professionals is not just to diagnose our patients by applying our scientific knowledge and clinical skills, but also to be the “communicator-in-chief,” “listener-in-chief,” and “reassurer-in-chief.” Any doctor who doesn’t fully grasp this, is not doing the best job they can or being the best doctor they can be. I truly believe that over 90 percent of our everyday job as a physician involves being a good ...

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Peg began internal medicine residency with altruistic goals. She didn’t want to become a specialist or seek personal financial wealth. She just wanted to help people. With a prior career related to her degrees in art history and sculpture, she had a unique way of truly embracing medicine as an art. Rarely spotted without a smile on her face despite long training hours in the hospital, she eagerly embraced taking ...

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For the last three decades, the numeric pain score has been the go-to assessment for acute pain in the hospital setting. Since this methodology was developed for research purposes to see if drug “A” had an effect on patient “A,” its clinical utility is not just worthless but dangerous. Let’s look at a simple example of a pain order set that is commonly used across the country. If a patient says ...

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Though the news at first stayed local in Philadelphia and the northeast, it’s gaining traction nationwide. ZDoggMD is on it. Bernie Sanders held a rally. What happened? The venerable Hahnemann University Hospital, the main teaching hospital for Drexel University College of Medicine in Philadelphia, is bankrupt and will soon close its doors after more than 170 years as a safety-net hospital serving inner-city patients. Why should we care? After all, there ...

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The recent Boeing 737 airline crashes have left a scar on the American (and worldwide) psyche regarding air travel. Boeing, an iconic brand, prestigious in history and talent, neglected to update and formally educate pilots regarding an essential software update which ultimately contributed to two fatal crashes, killing 346 people in total. Recent audio between an American Airlines pilot and Boeing's leadership offers some insight — and lessons — into this ...

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Physicians and health care providers across the world are trained to treat disease processes and disease states. Often, this approach becomes technical. And while directed towards the patient, it paradoxically distances itself from the patient. The distance created between the patient and the physician through diagnostic and therapeutic approaches is related to the patient’s dissatisfaction with their medical journey. Being sick and ill, whether it is a major or minor illness, ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. In the late 1800s, William Osler stated, “… if you want a profession in which everything is certain, you had better give up medicine.”  He made this observation at a time when the science underlying health care was nascent, and little was understood ...

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The other day, I happened across a YouTube video called the “Try Not to Look Away Challenge.” There were some obvious video clips, such as a person vomiting, a spider, and a spooky video game. What struck me was a clip from a movie in which a middle-aged woman forgets where the restroom in her house is located. After letting her husband know that she was headed to the restroom, ...

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I recently graduated from residency and fellowship. The last week in-house was a second adolescence. My moods have been up and down. I’d giddily return a parking pass, then surrender IT access in tears. No one could feel this — my — moment as deeply, specifically, or correctly as I could. What word is there for that? There’s song. Influenced by the new film Yesterday, I melodramatically equated my break-up with ...

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Recently, thousands of new residency and fellowship graduates have earned their wings and will be, mostly metaphorically, hanging out their shingles. Sadly, though, as the excitement of finally finishing training after decades of schooling wears off, even great work can become routine. There is a parable about three men laying bricks. When asked what they were doing, the first man said, “Laying bricks.” The second man said, “Building a church.” And ...

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When I decided to become a doctor, little did I know that medical school and residency would be like a hazing for future physicians. We are broken down mentally and physically and then remade in the image of the "strong" doctor and to admit to being sick is equivalent to being weak. We are publicly shamed for admitting we don't know the answer to daily pimping on morning rounds. We ...

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