Why is your hospital always full? Actually, it’s more than full.  You have twenty boarders in the ED. You turned your postop recovery unit into an overnight surge center.  Every day administrators beg you to please, please discharge patients, if possible before 11 a.m.  You’ve hired an army of case managers, dissected the discharge process, and held countless capacity management meetings, but you’re still bursting at the seams. It wasn’t always ...

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I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients. I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.) In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. ...

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Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection. We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children ... maybe you too ... was gone. We were devastated and saddened that the magic Muppet man had died. One year later, our ICU admitted ...

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My local hospital in an affluent suburb of New York City displays its Outstanding Patient Experience Award 2018 and Magnet Recognized status on its website. My experiences tell a different story. This hospital is located approximately five to seven minutes from my home and is my go-to in an emergency. I have multiple medical conditions, which despite my best efforts sometimes require emergency care and unfortunately admission. I was working ...

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It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on the man that gave me life! CPR on the person who just three months earlier ...

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How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal. When I get to work, full of nervous energy, I am relieved to find out ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit ...

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On a Saturday morning, Michael, a physician, was making his way through the hospital atrium after his weekend rounds.  On his way out, he noticed a family he knew well.  They were talking quietly and appeared distraught.  He asked them if they were okay.  They said that the husband’s mother had been admitted overnight with a malignant pleural effusion, and since all beds on the oncology floor were full, she ...

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I am a retired family physician (FP) and do extensive traveling in my RV. Since I have multiple medical problems, I attempt to carry with a copy of my medical records with me. I am often surprised by the information that is included in the office dictation or the hospital record and wonder how that information was obtained since it was not elicited by asking me for the info. Case in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. ...

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