The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as  2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure is ...

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An excerpt from Dottoressa: An American Doctor in Rome. When I migrated from the banks of the East River to the Tiber shores the path was strewn with bureaucratic boulders, land-mines, and pitfalls. I offer the tale of my odyssey as an object lesson to would-be fellow cosmopolites in that ...

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Lucas McClain started smoking cigarettes in high school but switched to vaping after he heard e-cigarettes were a safer alternative. His vape of choice became the Juul, the king of electronic cigarettes — which comes with a king-size nicotine hit. Now 21, McClain wants to quit so badly that he’s turning back to the problem he fled in the first place: good old-fashioned cigarettes. “Juul made my nicotine addiction a lot worse,” the ...

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A month ago, during a visit to her doctor’s office in Sequim, Wash., Sue Christensen fell to her knees in the bathroom when her legs suddenly gave out. The 74-year-old was in an accessible stall with her walker, an older model that doesn’t have brakes. On her left side was a grab bar; there was nothing to hold onto on the right. Christensen tried to pull herself up but couldn’t. With difficulty, ...

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Several weeks ago, I began my studies for a master’s degree in journalism. I’m continuing to work as a physician, but for the next two years, I’ll also be gaining knowledge in an important field: health communication. I recall being a medical student and observing the different ways in which my supervising doctors spoke with their patients. Some doctors communicated clearly and were easily understood. Others used words that I had ...

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The receptionist interrupted me in the middle of my dictation. “There’s a woman and her husband at the front desk. She’s already been seen by Dr. Kim for chest pain, but refuses to leave, and her husband seems really agitated. They’re demanding to speak with you.” I didn’t take the time to look up the woman’s chart. This could be a medical emergency, I figured. Something may have developed in just the ...

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More than 200 health organizations have now implemented OpenNotes. Many more are piloting, are soon to implement — or have implemented, and we don’t know it! For more than three years I’ve been fortunate to represent OpenNotes to potential implementers, and I’m confident I’ve heard almost every clinician concern or anxiety regarding what might happen when patients read their own notes. Here are the five most common concerns I’ve heard — ...

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A Health Affairs blog post titled "Fixing Clinical Practice Guidelines" echoed several concerns I've discussed previously: practice guidelines are being produced in abundance but often have variable methodological quality, financial conflicts of interest that threaten objectivity, and/or poor applicability to the clinicians and populations for whom they are intended. To address these problems, the authors reasonably suggested restoring funding for AHRQ's National Guideline Clearinghouse and ...

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It's 10 p.m. Seven days before Christmas. I'm sitting at work "finishing" up some charts. I am suddenly overcome with anger. What am I doing here right now at this minute? I am helping no one. This work I'm typing away at — trying so hard not to scream — it's hoops. Fucki*g hoops ... for insurance companies. So I can beg them to pay me. Pay me pennies for the hard, good, compassionate, humanitarian ...

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"I'm graduating and leaving our clinic in June." Over and over again, in the months leading up to this transition, I break this news to my primary-care patients. I have developed many meaningful relationships with patients over my past three years of training as a family medicine resident in a large, urban health center in Manhattan. But now it is time to leave and move on. The fluorescent lights in an overly air-conditioned ...

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