Archive for the ‘Lessons From the Practice’ Category


Phillip Kennedy woke up later than usual on Monday, January 27, 1997. He had a headache and fever, and he planned to stay home from work. I awoke at 5:45 AM, tired after a weekend on call. As I dressed in the dark winter dawn, I looked forward to coming home early. But, Phillip Kennedy was to die that day, and I was destined to share in his death.

Phillip was 54 years old with diet-controlled diabetes and alcoholism in recovery. I had cared for him in my internal medicine practice for seven years. Phillip usually saw me three times a year for routine visits and his annual physical. He was a gregarious, affable man with red hair and a ruddy complexion. Our interactions were friendly, natural, affectionate, and at times, playful.
canadian pharmacy

Phillip came to see me for his annual physical on Wednesday, January 22. He felt good and had no specific complaints. Phillip told me that, over Christmas, he had married June, the woman he had been living with for the past 12 years. June was 20 years his junior. Phillip said that there were parties surrounding the wedding and that he had started to drink again. He said that he was just celebrating with friends, not drinking excessively. Everything was under control.

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Saying No

Saying NoVICTORIA MAIZES, MD, Tucson, Arizona

Saying no to patients is not something that most physicians learn in medical school. Nor does it come naturally or instinctively. Rather, after years of trial and error, as patients ask for things that physicians consider inappropriate, physicians eventually develop a style that works for them.

How patients feel about their physicians’ saying no is another matter. No one likes to be told no. When physicians say no, patients often don’t return. They perceive themselves in a “one-down” situation. They may feel embarrassed and look for another physician.
Canadian Pharmacy

The specific situations are familiar ones. Whether the patient is asking for a third or fourth refill of Vicodin (combination product of hydrocodone bitartrate and acetaminophen) for chronic back pain, wants to be classified “disabled” for a problem that seems minor, or is convinced that magnetic resonance imaging is the only thing that will answer his or her questions, physicians have often heard these requests before. The automatic response often is to lecture the patient on why the request is not a good idea.

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WILLIAM E. BYRD, MD, Roanoke Rapids, North Carolina

Loneliness is not the sickness unto death. No, but can it be cured except by death? And does it not become the harder to bear the closer one comes to death?

Markings, 1966

Two weeks after I entered private practice, I met a man whose quick and unlamented departure from this world would create a lasting impression on my mind.

At 7 PM on Thanksgiving evening, I was called to the emergency department to see a 63-year-old man who had sustained a massive anterior myocardial infarction. Mr Evans, an unemployed plumber, developed severe chest pain after leaving a local Mexican restaurant. A rescue squad was quickly summoned, and he was transported to our hospital emergency department, where he was found to be hypotensive and in complete heart block. After thrombolytic therapy was initiated and a temporary pacemaker inserted by the cardiologist on call, he was then transferred to the coronary care unit. As soon as nurses had adjusted the oxygen and intravenous fluids, I introduced myself and began to take his history. Despite his precarious state, Mr Evans was pleasant and courteous, continually thanking the physicians and nurses for their care.

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So Many Advances in Medicine, So Many Yet to Come