The story of how a hospital is being sacrificed for money

Policy
September 20, 2017

There is a 4,300-strong grassroots movement known as “Save Our Hospital” gaining notoriety in Albert Lea, Minnesota. This story is symptomatic of the fact that hospital consolidation has slowly become a national pastime. With declining revenue under the Affordable Care Act, mergers increased by 70 percent, leaving small communities scrambling for health care access. The latest casualty in the “hospital-consolidation-for-sport” trend is Albert Lea, a small …

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This doctor spends more time at a computer than with patients

Physician
September 19, 2017

I find myself spending close to an hour on the computer each morning at the hospital. I spend this time dutifully looking up vital signs, labs, recent radiology or pathology results as well as many other valuable pieces of information about each of my patients. I watch as my colleagues frantically record values, while making sure to point out important trends and gross abnormalities.

When we round, there is always a …

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It’s time to stop it with the “routine” labs

Physician
September 18, 2017

“So, I’m getting routine labs on her.”

Wait, what?

Statements like these often make the hair on the back of my neck stand up. One of our residents was seeing a healthy young woman for her “annual physical,” seen just a few days after a routine postpartum visit with her OB/GYN after the uneventful birth of her third child two months ago.

The resident was coming for his afternoon continuity clinic from an …

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How to find joy in practicing medicine

Physician
September 18, 2017

My intern gazed blankly at her notes from the day.

“You OK?” I asked.

Her face was quivering with restrained tears as she turned to me, “I don’t think I helped anyone today.” This was not the first time, nor would it be the last time, that I had heard those words from a resident physician.

Medical training is no joy ride. How could it be? First, there is the intellectual challenge of …

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For women physicians, is there a connection between productivity and burnout?

Physician
September 16, 2017

Is the practice of medicine a different experience for male and female physicians? Two recent studies from athenahealth suggest that it is — in ways that should make us rethink what we value in health care.

The first study found that male physicians are more productive than their female counterparts. In an analysis of 47 million visits on the athenahealth network in 2016, male physicians generated 30 to 40 percent more …

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How anti-vaccine parents are finding doctors willing to exempt their kids

Conditions
September 16, 2017

Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons.

Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She …

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The surprising sleeping arrangements of an emergency physician

Physician
September 15, 2017

I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time.   During that time I stayed in a lot of hotels.  But, occasionally, I had more unique accomodations.  Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal.  I actually like sleeping in airports occasionally.  When you’re stuck, you’re stuck.  Weather or …

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What does it mean to be a progressive doctor?

Policy
September 15, 2017

A curious post popped up on my Facebook feed recently: “Another doctor running for office!” A picture of an attractive family was nestled below that exclamation, asking to show your support (in the form of dollars) for this doctor running as a Democrat for the House of Representatives. It had that sense of enthusiasm that implied I was obligated to be excited, but instead came off more like Jeb Bush’s …

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This South Pacific island will change how you think about health care

Physician
September 15, 2017

For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high …

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Take back our practices with physician cooperatives

Physician
September 14, 2017

One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed.  The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.

Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are …

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A resident deals with being a wife, mother, and doctor

Physician
September 14, 2017

As a second-year family medicine resident, wife of a nurse and mother of an almost-two-year-old, the feeling of just not being enough has a suffocating hold on me some days. Non satis. Sounds like a pretty good gig when I talk with others outside the medical profession and friends from home. Training to be a doctor? Great. Happily married to an amazing man who’s taking time off work to raise …

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Stop exploiting medical students and residents

Physician
September 13, 2017

Approximately 300-400 physicians commit suicide annually. Given that a typical doctor has about 2,300 patients under his or her care, that means more than a million Americans will lose a physician to suicide this year.

In a study of six medical schools, almost seven percent of students said they had thought of ending their lives in the last two weeks. In another recent study, 29 percent of residents …

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Health care reform: A free-market solution works in other countries

Policy
September 13, 2017

Repealing and replacing the Affordable Care Act is on indefinite life support. The political consensus was that President Trump needed to pass health care reform to be able to move forward with his legislative agenda. While this may be true, the passing of any repeal and replacement bill without fundamental reforms has little chance of long-term success, likely defining Trump’s presidency as a failure no matter how successful he is …

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When we talk about quality, what exactly do we mean?

Policy
September 12, 2017

It’s a health care buzzword for sure, but when we talk about quality, what do we mean? We can compare the quality of similar things and focus on its absence, but otherwise, putting the idea into words becomes complicated. Context is important. And so is perspective: One’s position within the health care system influences how he defines quality to a larger degree than it does at a restaurant, or in …

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Let’s not be petty about affirmative action in medical school

Education
September 11, 2017

Just a year after the Supreme Court rejected a challenge to race-conscious admissions in Fisher v. University of Texas, this issue is being pushed back to the front of the room by none other than the Trump administration’s Justice Department hauling out hoary tropes about “reverse discrimination.” They are preparing cases against Harvard and the University of Pennsylvania, charging to the rescue of the multitudes of …

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A love letter to patients

Education
September 9, 2017

This is a letter to everyone who has ever smiled, shrugged their shoulders, or nodded while either hesitantly or enthusiastically uttering the words, “Yes,” “Sure,” “OK,” “I guess so,” or, “Of course,” when a medical student has asked if he or she can talk to and examine you before your doctor comes in. We know that you are busy and that your time has value. We know that you have …

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I vow not to call my patients “difficult.” Here’s why.

Education
September 9, 2017

I am not a doctor.  (Yet.)  I am a novice third-year medical student, somewhat able to perform and document a physical exam on a sleeping child, to dial the correct number to call a consult and to make wild guesses about chest X-rays (“I see a consolidation?”). I write about medicine not from a position of experience, but of malleability.  I want to become like the best doctors I see.

Towards …

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A reminder that physicians are artists

Physician
September 8, 2017

Anyone entering medical training is taught that medicine is an art, one that combines scientific knowledge, discovery and application with its practice. It is both art and applied science. It should never become nor has it ever been only all one or the other.

To be medicine at all, the noble vocation that so many brilliant minds sacrifice to pursue in service to their fellow humans, the practice must balance art …

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A cancer survivor embraces the light of going to medical school

Education
September 8, 2017

This article was originally presented as student remarks at the 2015 Harvard Medical School commencement. 

At the end of medical school, I always return to a musing, a zen koan of sorts from Dean Jeffrey Flier. At my white coat ceremony, a close friend and current resident, Dr. Nina Gold was chatting with the dean about the heft of our newly bestowed bright white coats. He asked her, in one beautiful …

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