At six-week intervals, I replenish my supply of omeprazole. Initially, I took it for symptomatic relief of GERD, becoming symptomatic again within a week or two during periodic self-directed suspensions. An esophagogastroduodenoscopy, done for another reason, disclosed Barrett’s esophagus, shifting that daily pill of personal comfort to a more essential intervention. It falls within several Gastroenterology Society recommendations as a component of later malignancy prevention. My weekly pill case, set …
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One of the not often discussed challenges of our EHRs may be getting patients to the right medical resource at a time most suitable for their medical condition. Our electronic systems, whether automated by algorithm or assigned to a person given a protocol have become too separated from medical care itself. Our schedulers are no longer ourselves or our secretaries trained in the variability of patient needs, which can then …
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My email delivered a terse reminder. The board of medicine notified me that they had not yet received my license renewal application, just one month until the expiration of my current license. For a mere $100, I could sit through the required online child abuse reporting course and answer the questions as they arise. My CME is more than ample, as my other state license requires far more and is …
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COVID-19 melted down the world at a very inopportune time in history. Just as medicine was getting a handle on previously intractable conditions, from sophisticated diabetes management to less invasive surgical procedures, a new threat that devastates our population with few good treatments overwhelms health care.
Medical workers come to the rescue, as we always do, though at a personal and communal price. Somebody else keeps our food available, allows our …
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For a mere biennial fee of $525, I remain part of the medical community with a newly renewed medical license from my home state. I still have time to make a decision on renewal for the state from which I retired two years ago, only because their board extended its deadline three months to allow its physicians to complete the CME that our pandemic made more difficult.
It costs less but …
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After I retired, our regional medical center realized they had accumulated scores of physicians of major capability and stellar professional reputation whose careers had either concluded or entered their closing years. Though I had retired from a different institution, I had been on staff there for twenty years, so they graciously absorbed me into their newly created senior physicians advisory group. Its purpose and activities remain in evolution with periodic …
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As a resident in the 1970s, I used to receive the AMA weekly newsletter. A squib of a few paragraphs noted that the Alabama Medical Board had issued a reprimand to a surgeon for suturing the hand of a young African-American man, then removing the sutures when the fellow did not have $25 on him to cover the fee. The surgeon contested, indicating that a patient should have the expectation …
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Many moons ago, in the 1970’s era, when no imposition from physically brutal on-call schedules to laudable scut to demeaning attendings was outside the boundaries of the house staff training curriculum, our leaders informed us that we were being introduced to the worst-case medical environment. That familiarity with setting aside our own creature comforts would enable us to save patient lives when the circumstances demanded our resilience.
Not quite two years …
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Sixteen months into retirement, the absence of any externally imposed schedule still leaves me partly edgy. Medicare, COBRA, and cell phone bills come due at expected dates. The check goes out the next day, but it could wait another day or a week. Shabbos commences and concludes as the cycles of nature require. If I miss a meeting or an Osher Lifelong Learning Institute class, there are no demerits. In …
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While my forty-year parts warranty expired some time ago, leaving me with a snapped fibular styloid process not long after, the ensuing twenty-five years have not resulted in any serious medical encounters until last week. Following a very pleasant early evening session with our Congresswoman and a sweet snack at home, abrupt abdominal pain progressed in under two hours to a clinical acute abdomen. As I got dizzy and dependent …
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When I was on staff at a large medical center, the CEO established four core values for the institution which he arranged in a diamond pattern: safety at the apex — think of yourself as a patient expectedly at the bottom.
While it seems hard to assess how seriously this widely displayed mission statement was taken, or if anyone really remembered which value went in which corner, the institution expanded. Thinking …
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Doctors by our nature do not handle idleness well. We value our vacations, of course. I never sought out a study to see if doctors vacationed differently than others. Some probably hang out someplace warm, others seek out the best eats of the place they are visiting, some cannot wait for the cruise ship to dock so they can disembark for a tour of a new place. Vacations, though, are …
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Six months have elapsed since exiting the pageant of my hospital via retirement. Like many people who devote countless hours to professional activities, some mandated, some by compulsion to detail, this windfall of unstructured time, no matter how well planned, can prove disorienting. My final destination was a small inner-city hospital, preceded by twenty years affiliation with an enormous comprehensive regional center. The people there, near where I live, have …
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As each calendar year closes, organizations compile best/worst lists: TV shows, movies, exceptional people that bring character or immortality to our year as it fades into history.
Medicine has its heroes and scoundrels. I would expect that all physicians can instantly name five teachers who shaped them and five guys they scored as real zeros on their evaluation forms. For the benefactors, we not only gave them higher scores but assimilated …
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Retirement has gotten me edgy. Three months after departing, I had begun spending too much time horizontal, which I forced myself to remedy but then finding myself with nothing to do.
Moreover, things have gotten more noticeably like Bowling Alone, an often-cited book by Robert Putnam published in 2000 that describes attrition of diverse communal activities over the previous 30 years. For physicians, our daily activities prevent us from working in …
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My medical center recently cemented an agreement with the Veterans Administration to offer care to veterans who could not be accommodated at the VA. We need paying patients, they need doctors of our caliber — establishing mutual benefit. Military veterans have always been among our patients. During my professional lifetime that has included men of my father’s generation whose young adult years encompassed World War II’s widespread draft. World War …
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Just over a month has elapsed since my retirement from patient care. I’ve been to one grand rounds at my prior medical center, encountering a smattering of old friends, some preceding me to retirement, others in active discussions with their financial advisers and others a mixed multitude of residents and students assigned to the secondary campus that month looking upon us geezers in the small video access conference room with …
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One day, I was full of moderate despair, overworked, befuddled by the EHR with a tinge of burnout, staring at my computer, I treated myself to something I’ve not done before. It was my 62nd birthday that day, and I gave myself a birthday present. Before rising from that swivel chair, I had written down on a sticky pad the day that would be my retirement date, exactly one year …
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Too often, residents want you to address something, so they don’t have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID.
For me, one example seemed rather routine: a diabetic with another medical illness. It wasn’t terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady …
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From the earliest days on the clinical wards, everyone probably worked with a senior physician who knew how to game the system. It might be doing a rigid sigmoidoscopy on admission for every patient who had a rectum — something not the standard of care forty years ago. Or maybe it was accepting a pharmaceutical company subsidized tax-deductible junket under the guise of CME at a place with sparkling white …
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