The last few passengers filter in and buckle themselves up before takeoff. The emergency exit row is occupied by an elderly couple, and I am seated behind them. The flight attendant asks whether they are comfortable in those seats, given that they’d have to respond in the case of an emergency. “Not that I expect anything bad to happen,” the flight attendant adds with a smile. I, too, am familiar with discussing ...

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If patient-centered care is the current winning game plan for health care, then shared decision making (SDM) is the secret weapon. But we physicians need a new way to approach it. SDM, as defined by the Society for Medical Decision Making, is “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patients values ...

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This open enrollment season, patients will be considering their health care coverage for the coming year. To ensure they are fully utilizing their primary care benefits and building relationships with health care teams that will keep them healthy, we need to encourage them to connect with a primary care practice or medical home. A medical home is a place where a patient can seek treatment from primary care physicians and other ...

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Scourge:

  1. An instrument of punishment or criticism
  2. A cause of wide or great suffering
  3. Whip or lash -- especially for torture
Introduction They say you never forget your first time. I remember mine, vividly. If only I could erase the memory. I had high expectations and higher hopes, but what I got was disillusionment. I felt violated and humiliated. I’m talking about my first time using a system for electronic health records ...

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While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor "did not care" about her, as he sent "fake doctors" (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the ...

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Healthy or not, everybody has his or her share of frustrations in life. The chronically ill don’t have a corner on that market! This piece focuses on frustrations that are unique to those with ongoing health issues. I’ve experienced all of them as a result of being chronically ill with a debilitating illness that settled in after I contracted what appeared to be an acute viral infection in 2001. Here are ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. As part of my role in International Programs at the American College of Physicians (ACP), I have a unique opportunity to travel frequently and engage with internists around the world. In fact, I am writing this while almost 7,000 miles away from home, ...

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Periodically we should reflect on what challenges face patients and physicians.  Over the past few days, I have worked on a list of the issues that concern me the most.  I welcome suggestions for expanding the list. 1. Diagnostic errors. All patient care requires that we make the proper diagnosis.  Too often we make errors.  A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis.  A similar ...

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Many physicians have become world famous writers, and in Greek mythology, Apollo was the god of both poetry and medicine. I can personally think of many prominent physician writers I have come across in my reading over the years: There was the 12th-century rabbi Maimonides, Copernicus in the 15th century and the poet John Keats in the 1700s. In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan ...

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Mrs. Smith is an 81-year-old female. She worked a long time doing very physical work and is now on a fixed income and comes to my office with chronic pain. X-rays show she has degenerative arthritis in her hips, knees and lumbar spine. She has taken Norco twice a day for years and has been able to be very stable on this. She has always been compliant with her medications. ...

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