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The “Big Picture” Benefit Of Primary Care

Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?”

“Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden, and have actually shared some in that load, being the doctor for the whole family.

I’ve also taken care of her parents, who had their own psychological problems. They were difficult patients for me to manage, and they had died long enough ago that I had forgotten that difficult chapter of her life. I’ve helped her with her emotional struggle from all of this. It was hard, but she hung on as best as she could. I know. I was there when it was happening.

To me, this is the biggest benefit of primary care. Yes, it’s nice to have a doctor who knows what’s going on with all of your other doctors. It’s good to have a doctor you are comfortable talking with about anything. It’s good to have someone without a financial stake in doing surgery, performing procedures, or ordering tests. But the unique benefit a long-term relationship with a primary care physician (PCP) is the amazing big picture view they have. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Dating An American Medical Student? Some Financial Advice

The average medical school debt today, according to the Association of American Medical Colleges, is $156,456.

The United States is the only country in the world were future doctors have to bear such a financial burden of their education. That places significant strain on any relationship involving an American medical student.

Recently, there was an interesting piece in the New York Times discussing this very issue. The article profiled a female medical student who had amassed $250,000 of school debt:

Still, if she and [her boyfriend] Mr. Kogler are going to move in together and get engaged, she wants their financial arrangements to be clear and fair. But how do you define fair when you’re bringing a quarter of a million dollars in debt to a relationship?

Indeed. It’s an issue that’s rarely discussed, yet frequently encountered by medical students. With that degree of debt, there is little room for flexibility should one’s future plans change. You have to continue working to pay off the loan. Read more »

*This blog post was originally published at*

Live Longer With Strong Social Ties

A study published in the July PLoS Medicine is getting a lot of press for its conclusion that strong social networks are related to increased lifespan.

The meta-analysis of 148 studies involving 308,849 people found that those with stronger relationships were 50 percent more likely to survive over 7.5 years of follow-up. What’s more, the researchers reported that a lack of strong social ties is as bad healthwise as drinking or smoking, and worse than not exercising or being obese.

But although the association between strong social ties and improved longevity seems robust, other factors could be at play, and applying the findings in clinical practice could be difficult. And sorry, Facebook fanatics: Online “friendships” aren’t thought to count as much as in-person ones do. (PLoS Medicine, New York Times, TIME, The Atlantic)

*This blog post was originally published at ACP Internist*

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