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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a1.htm http://www.dopl.utah.gov/licensing/forms/OpioidGuidlines.pdf http://health.utah.gov/prescription/ http://www.cdc.gov/nchs/data/databriefs/db22.pdf Ballantyne, Jane C. MD et al. "Efficacy of Opioids for Chronic Pain: A Review of the Evidence." The Clinical Journal of Pain 2008 Jul-Aug; 24(6) :469-78. Ballantyne, JC et al (2003 Nov). "Opioid therapy for chronic pain." New England Journal of Medicine 2003 Nov 13;349(20):1943-53. Eisenberg, Elon et al (2005 Jun). "Efficacy and Safety of Opioid Agonists in the Treatment of Neuropathic Pain of Nonmalignant Origin. Systematic Review and Meta-analysis of Randomized Controlled Trials." JAMA . 293(24) , 3043-52. Martell, BA (2007 Jan). "Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction." Annals of Internal Medicine. 2007 Jan 16; 146(2) :116-27. -----------------------------------------------...

I think I finally feel compelled to just go ahead and expose and explore the next level of this topic that I am interested in discussing. My disclaimer is that this is an opinion-in-progress for me... A controversial one, and it is not fully developed. Furthermore, by sharing this, I fully recognize that I am opening a topic to a potential audience of every kind of difference in belief systems surrounding this topic, experiences, ideas about what it means, and so forth.. However, that is part of what makes this topic so fascinating to me. Palliative care is fascinating precisely because of that variety of beliefs and opinions. I went to a lecture tonight hosted by a medical association composed of women physicians in Utah. I would argue that this is a very specific and self-selected group.. Still, it was startling to observe the differences in interpretation and opinion that surfaced during the discussion. The lecture was essentially about the topic of palliative sedation in cases...

I've been thinking about the concept of limits and compromise, and how that affects the way I live my life. I got on a plane to Minneapolis for my first vacation in over 8 months. A few seconds after sitting down, with no indication whatsoever as to who I was or what I was thinking about, in the instant of initiating my mindless vacation by unwrapping my blanket and ordering a tomato juice, this guy sitting next to me says, "So what are your plans?" I looked over at him with a mixed glaze of: are you kidding me? what did you just say? i don't know. i don't want to talk about it. do you have ideas? why are you asking me this? i think i'll just stare out this window and pretend i didn't hear you... He started talking without any response from me... And giving me advice! How odd!? He went on a maybe 10 minute diatribe about what he thinks I should do with my life. He knows NOTHING about me. I'm not joking. He recommended pushing the edge. Trying s...

It was interesting to be home again. I have really been dreading the topics that I knew would come up. Dreading. Primarily because I decided I do not really intend to go directly home after residency, and I know my family expected me to... or if they do not expect it, they really want me to come home. But secondly because I am not at the phase of life that I am " supposed to be" at this point.. This imposed sense of failed anticipation has been growing slowly and insidiously, and I have noticed it has been creeping a shadow over my time at home.. These topics are inescapable. In many ways, I do not feel like I owe anyone any explanation to any of these questions. Mainly, this is because I feel that I have been at least moderately successful so far in my life, and I have done this while maintaining solid relationships with people who are important to me. Also, I experience my life to the maximum extent that I know how to do it at each stop.. I think I have been living richl...

I've been waiting for this to happen to me. For quite some time, I have known there might come a time when I may no longer care about anything related to my job... Recently, I got called in to work a 24h call shift that I forgot I was supposed to be working. If things don't make it onto my Google Calendar, they do not exist to me. There are too many demands that have no pattern whatsoever for me to keep track of them all. It is absolutely ridiculous. So, yesterday I was scheduled to be the senior on the medicine service with a new intern. After last night, I have now worked with every single new intern on either their first or second call shift as a resident ever..... I drew the short straw there. But, actually, the interns are all pretty great and it is sometimes fun and amusing, and even occasionally refreshing to be around people who are excited, nervous, and curious about this job before those feelings inevitably get replaced by apathy and cynicism.. or emptiness. I ...