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When A Crazy Patient Is Actually Right

Sometimes in this job you just get lucky.  You have an elusive and/or dangerous diagnosis just dropped in your lap.  Something devastating that you would never have been able to tease out otherwise just gets handed to you by the patient.  There’s a catch, though: you have to be smart enough to know when to listen to the patient, when not to blow off their crazy talk as just crazy.

So it was recently when I saw a guy with back pain.  From the chart, it didn’t sound like anything complex: a middle-aged to older guy, maybe 60 or so, with a history of chronic back pain and multiple surgeries for the same.  He was on Oxycontin 80 mg three times daily (a very high dose, and a red flag for an ER doc naturally suspicious of drug-seeking behavior).  I went to see him, and it was clear in seconds that this dude was JPN: Just Plain Nuts. Read more »

*This blog post was originally published at Movin' Meat*

The Friday Funny: A Retired Veteran’s Surgical History

So I’m working on my history and physical examination and I ask my 87 year old retired vet what types of surgeries he’s had done.

“I’ve had every surgery in the book”, he says
So I asked him, “Have you had a sex change operation?”
“Well, no.  I guess I haven’t had everything done.”

After a good group laugh, I went off to eat lunch.

*This blog post was originally published at The Happy Hospitalist Blog*

A Classic ER Patient: A Poem

Classic presentation of the perfect patient

“What’s the problem? You’re the doctor,

why don’t you tell me!

I’m suffering an awful lot it must

be plain to see;

I’ve got back pain from that car wreck

back in nineteen sixty-five.

If I’d have worn my seat belt

there’s no way I’d be alive!

I’m out of my prescription and I

need help, I’m afraid.

I ain’t worried ‘bout the price, you see

I got my Medicaid. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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