Medical Record Challenges -- A Subtle Sign of a Potentially Impairing Condition? by Judith Eaton, MD
Doctors learn early in their training that one important and unavoidable part of their job is to complete medical records in a timely fashion. As house staff, their paycheck may be withheld for failing to do so; as attending doctors, they may lose admitting privileges.
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The License

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The License
Maybe some of you have a parent who has gotten to the age when driving a car is no longer safe. Not long ago, my 90 year old father passed out in the middle of busy intersection and shortly thereafter proclaimed himself fit to return behind the wheel.
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Work-Home Conflicts have a Substantial Impact on Career Decisions that Affect the Adequacy of the Surgical Workforce by Liselotte N. Dyrbe, MD, MHPE, et. al
Abstract Objective To evaluate factors associated with work-home conflicts (W-HC’s) of US surgeons and their potential personal and professional consequences. Design Cross-sectional study. Participants Members of the American College of Surgeons.
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Anxiety Among Physicians by Doris C. Gundersen, MD, Colorado PHP Medical Director, and President-Elect of the Federation of State Physician Health Programs
Because of stigma (feared or real), overwork and denial of vulnerability, many physicians do not take good care of themselves. Yet we are not immune to those conditions or illnesses we encounter in our medical practices on a routine basis, independent of specialty.
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BURNOUT - Yesterday, Today and Tomorrow A Realistic Perspective  G. J. Heymach, MD, PhD, FACP Associate Medical Director
Physicians have always had burnout problems, it’s inherent in their personalities and the occupation they have chosen. T. Jock Murray, MD, the director of the medical humanities program at Dalhousie University in Halifax was quoted3 in a 2001 article as having said, “We want people who are driven, who are compulsive, who can excel at anything that they do. What do they do when they get into practice? They try to do everything, and they have this complex which also says they must succeed at eve...
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Never Face a Medical Board Investigation Alone

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Batya Swift Yasgur, MA, LMSW Introduction When endocrinologist Francine Fitzhugh (not her real name) opened her mailbox, the last thing she expected was a letter from her state's Medical Board. "An obese patient filed a complaint against me, stating that I was responsible for her 36-pound weight gain."
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Have You Been Stalked?

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Have You Been Stalked?
You may not be alone. Recent studies indicate that about 15-20% of physicians have been stalked at some point during their careers. As physicians often don’t report these incidents, experts think the numbers are higher than reported. Stalking can vary between seemingly innocuous behavior to more intrusive and concerning behavior such as loitering around the office, sending gifts or threats, excessive curiosity about your personal life, or worse.
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Malpractice Rates Lower Among PHP Participants

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Malpractice Rates Lower Among PHP Participants
Findings from a study recently presented at the AMA/CMA/BMA International Conference on Physician Health showed that although starting from a higher risk category, PHP participants decreased their risk to 20% below that of a non-PHP group after monitoring. Michael Gendel, MD, a Denver psychiatrist and medical director emeritus of the Colorado PHP suggested that “one advantage of PHP participation is increased safety and not just better health”.
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Spotlight on Cathy Hodgson, Ed.D, Springfield Regional Coordinator
Just last week a new family client asked, “... so you think people can really change?” Although commonly asked, it is a strange question to ask those of us in counseling services. If we didn't believe change was possible, why be a counselor? I finished my undergraduate degree at Drury University and went to Missouri State University for my Master’s in Guidance and Counseling.
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Tips From Dr. Bill W.: Are You Really in Recovery?

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Tips From Dr. Bill W.: Are You Really in Recovery?
If you are a physician requiring the assistance and/or monitoring of the Physicians Health Program (PHP), then you are like me. If you have a problem with substance abuse or other addiction, then you are like me. If you are in recovery, then you are like me. Or, are you? Compliance with the monitoring requirements of PHP is a really important accomplishment, but it does not mean that you are in recovery.
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The Pitfalls of Giving Free Advice to Family and Friends by Shelly Reese
Everyone Wants Free Advice There are some situations for which medical school simply doesn't prepare you. Consider Thanksgiving dinner, when Aunt Myrtle buttonholes you about a recurring rash that's been bothering her. Or the sideline consult that one of the parents at your kid's football game wants to have, right after her son lands awkwardly trying to catch a pass.
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Thoughts on Legalization by Jon Shapiro, MD Medical Director, Physicians’ Health Programs of the Medical Society of Pennsylvania
Our recent trip to the PHP [Federation of State Physician Health Programs] conference in Denver highlighted some of the controversy surrounding the recent legalization of marijuana. It has raised several complex issues. I endorse the American Society of Addiction Medicine policy on medical marijuana.
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Malpractice Claims Decrease in Monitored Physicians

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Malpractice Claims Decrease in Monitored Physicians
Research presented at the 2012 AMA/CMA/BMA International Conference on Physician Health in 2012 showed physicians who are monitored by a physician health program (PHP) reduce their risk of a paid malpractice claim to 20% below that of non-monitored physicians. Michael Gendel, MD, Medical Director Emeritus of the Colorado PHP, suggests that PHP participation not only leads to better health but also to increased safety.
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Decision Fatigue Contributes to Prescribing Practices
New research published in JAMA Internal Medicine points to fatigue on the part of prescribers affecting the number of antibiotic prescriptions written, which may be contributing to the rise in antibiotic resistance.
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Vanderbilt Study on Physician Suicide Risk

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Vanderbilt Study on Physician Suicide Risk
A recent study done by Vanderbilt University of 141 Tennessee physicians evaluated for fitness-for-duty assessments found an “astoundingly” high rate of suicide if the physician was 1) found unfit to practice, 2) was in solo practice, or 3) if he/she was taking benzodiazepines (anti-anxiety drugs).
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Tips From Dr. Bill W.

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Tips From Dr. Bill W.
Alcoholics and Narcotics Anonymous are just that. . . anonymous. And physicians have a particular concern regarding anonymity because of the public trust required for them to function effectively. Simply put, we are concerned that, if the word gets out, others who don’t understand the program will derogatorily label us publicly as alcoholics and/or addicts, thus negatively affecting that public trust.
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Too Much Information -- The Ethics of Self-Disclosure by Kelly A. Curran, M.D.
“New admit,” the page reads. “14 y/o F r/o IBD, needs c-scope.” In person, the patient is spunky, sassy, filling the team’s day with joy. She dreams of professional dance, being en pointe under the bright lights. She is a fair sprite, ghostly pale after months of bloody diarrhea. After answering our questions, she declares that the hospital isn’t such a bad place and hunkers down with a Cake Boss marathon on television and several liters of prep.
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Understanding the Disease Concept of Addiction

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Understanding the Disease Concept of Addiction
Nowadays, as in 1951, the very mention of the disease concept of addiction arouses passionate reactions, both positive and negative. While proponents of this concept are fervent in their belief, they often do not have a clear articulation of what this phrase means, or the actual mechanisms and dimensions of this disorder. Critics often argue that this is merely an excuse for addicts to avoid responsibility for their behavior. Rarely is there a middle ground sought or found.
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The Disease Concept of Addiction Revisited by Richard S. Sandor, MD
Richard S. Sandor, MD, practices psychiatry and addiction medicine in Santa Monica, California. He is a past president of the California Society of Addiction Medicine and is the author of Thinking Simply About Addiction (March 2009, Tarcher/ Penguin).
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Alcohol Abuse Among Physicians: Taking Control

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Alcohol Abuse Among Physicians: Taking Control
Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices.
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Tips From Dr. Bill W. – March 2015

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Tips From Dr. Bill W. – March 2015
As I write this column, I am grieving the recent loss of a friend to alcoholism. What makes this event more painful is the fact that it clearly illustrates the importance of recovery over abstinence, the very theme of my column.
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A Message from Bob Bondurant

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A Message from Bob Bondurant
Dear Friends and Colleagues, It has been a while since I have addressed you in our newsletter. I am taking this opportunity to present a serious matter. In our now 30th year, the MPHP has
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The Physician Lifeline - March 2015

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The Physician Lifeline - March 2015
Dear Friends and Colleagues, It has been a while since I have addressed you in our newsletter. I am taking this opportunity to present a serious matter. In our now 30th...
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When Is It Okay to Date a Patient? Medscape Ethics Report 2012 by Shelly Reese
Introduction To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor - if the would-be paramour is a patient - it’s also unethical. But physician responses to Medscape’s 2012 ethics survey clearly indicate that many physicians aren’t willing to condemn every romance. When asked, “Is it ever acceptable to become involved [in] a romantic or sexual relationship with a patient?” more than two thirds (68%) of the 24,000 doctors who responded resoundingly say “no.”
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‘Disruptive’ Physicians Can Receive Treatment by Marcia Frellick
Slamming a portable X-ray machine into a wall in front of a patient. Screaming at a nurse. Throwing instruments. Death threats. All of these infractions are reasons physicians have been referred by hospitals, medical boards, and even their own attorneys to programs that assess their behavior and work with them to correct it. However, even less-dramatic behavior seen by a coworker as passive-aggressive, manipulative, or threatening can result in a referral as well, leaders of the programs s...
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Ten Surprisingly Simple Ways to Avoid a Malpractice Suit by Jeffrey D. Brunken
Even the best physicians face the possibility of a lawsuit nearly on a daily basis. However, research shows that many lawsuits today are not about medical errors, but about poor communication and misunderstanding. Ensuring effective communication should become a systematic and integrated approach into overall efforts to minimize errors, improve outcomes, control med-mal costs, maintain contracts and manage the reputation of your practice.
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Deal with Physician Impairment Before It’s a Safety Risk by Karen Caffarini
Attorneys and experts recommend that practices have policies that address how to define and handle a colleague who might represent a safety threat to patients. An impaired or incompetent physician can be a liability to a medical practice and pose a safety threat to patients. Still, some practices have found it difficult to discipline or report such a physician, especially if he or she is a partner in the practice or a longtime colleague with a previously impeccable career.
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Problem Prescribers Identified

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Recently in the news, CVS Caremark announced that it will stop filling opioid prescriptions for physicians classified as “excessive prescribers”. Excessive prescribers were classified on the basis of those who wrote opioid prescriptions for younger patients, patients paying primarily with cash or for those people driving long distances to fill prescriptions. Those practitioners that stood out were “prescribing 20, 30, up to 50 times as much pain medication as the average prescriber...”1
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What Happens When Your Physician Health Program Fails to Exist and Three Options for Maintaining Sobriety by Robb Hicks, M.D.
Physicians are highly influential role models for their patients, colleagues, families and the public at large, and that esteemed status makes their personal well-being a key determinant in health promotion, as noted by the American Medical Association¹. Nevertheless, medical professionals are not immune to the risk factors which make the general population more susceptible to developing addictions, including but not limited to genetic predisposition, childhood trauma and the presence of anxiety...
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I can remember back to the first time I saw pornography. I was walking home from school in the first grade and found a single page from playboy [sic]. I took the page home and hid it in the bathroom. I felt so much shame about having it, but at the same time was compelled to keep it so that I could look at it again. This week my children graduated from kindergarten and them term first grade was mentioned. I was immediately reminded of my experience that day walking home from school and a huge...
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Policies Targeted Toward Aging Physicians May Keep Doctors Working Longer, Smarter by Kim Krisberg
Orthopedic surgeon, Ralph Blasier, M.D., J.D., has voluntarily set an end date for his time in the operating room--age 65, about three years from now. “I want to make sure I stop before I lose my skills,” said Blasier, who works in private practice in ... Michigan. “The surgery is what I really enjoy, so if I’m going to stop surgery, I might as well stop seeing patients.”
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Molly, Kay, Georgia Home Boy and Mary Jane CLUB DRUGS
Creative street chemists never run out of ideas about how to come up with designer drugs that can be abused. These drugs are usually marketed to young people as a safe, fast way of getting high. Numerous cases of date rapes, bad trips and deaths have been linked to their use.
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A New Concept in Educating Chief Residents-An Example for Others
Recently, St. Louis University, invited our Executive Director, Bob Bondurant, to speak to their Chief Residents. The administration of St. Louis University decided to offer a program about four years ago to present information for their Chief Residents that is not typically covered in their core curriculum.
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I’m the oldest of 13 children. I was born in northeast Kansas to German and Irish parents and raised up in the Catholic tradition. I spent most of my childhood and adolescence on the plains of eastern Colorado and western Kansas helping in family farming and ranching ventures. I entered military service in 1970.
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Count the Full Cost of Retiring Your Medical License Before You Do It! by An Anonymous Physician
In 2008, after a long and successful career of some 28 years, I decided to branch out and start a new business. It happened to be the delivery of telemedicine to non-urban communities, and after some two years, the company had gained substantial traction and I was making a respectable income. All the while, I had not had occasion to practice clinically, so I began considering the idea of simply retiring my license and leaving clinical medicine for good. After all, the requirements of maintaining...
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Correcting Some Myths by Robert Bondurant, RN, LCSW Executive Director
A major deficiency still plagues the MPHP! As we begin 2014, I would like to revisit what this is and ask for your help. During 2013 as I would interact with a variety of administrators and physicians, I again found that the range of services that we offer is not well known or remembered. What really caused me to pause and reflect on this was the termination of a highly qualified physician who could have benefited from some legitimate help. The group he was associated with responded to his is...
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Addiction Q & A with Kevin T. McCauley, M.D

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Addiction Q & A with Kevin T. McCauley, M.D
1. Is addiction a disease? What are the arguments for and against this notion? People often disagree with the idea of calling addiction a disease in the same way we call conditions like diabetes a disease. The behavior of addicts is frustrating, ugly - even criminal. How can driving drunk be a symptom of a disease?
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Emotional Sobriety: The Next Frontier for People Recovering from Addictions By Robb Hicks, MD
Recovery is oftentimes misunderstood only as abstaining from addictive substances and/or activities, when in fact it is our life-long journey to restoring relationships with our inner self, God and others. In the first of the 12 steps, we admit we are powerless over our addiction(s), and acknowledge our lives have become unmanageable.
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A New Day is Dawning

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A New Day is Dawning
I am so pleased to announce that Cedar Bridge, located in Joplin, Missouri, a private residential treatment center, designed to treat physicians with drug and alcohol addiction has been approved by the Missouri Board of Healing Arts for the referral of Missouri physicians.
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Jayne Niskey, PhD, SE Missouri Regional Coordinator

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Jayne Niskey, PhD, SE Missouri Regional Coordinator
If you would ask Dr. Niskey how she got into the field of psychotherapy, she would say a murder and a friend’s drug-related death. 1 Prior to these two events, she was teaching school in California with the Los Angeles City Schools. It was there that the first event occurred when one of her young students thought little of murdering his father with a butcher’s knife.
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When Bad Behavior Can’t Just Be Dismissed

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When Bad Behavior Can’t Just Be Dismissed
Scenario: how do you help a disruptive colleague?
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Message from the President by Warren Pendergast, MD
It has been my great privilege to serve as your FSPHP [Federation of State Physician Health Programs] President for the last two years. Together, we have accomplished a number of great things, and have set more in motion. I’d like to highlight one of FSPHP’s primary areas of work over the last year......
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Physician Suicide - A Problem for our Time by Gary Carr, MD, FAAFP, FASAM
Introduction Statistically, it happens somewhere in America about once a day. Suddenly someone’s mother or father, a spouse, a friend, a colleague - a fellow physician - ends his or her own life. Those close to the physician, family and coworkers, are devastated. The physician’s patients are confused and sad as well. We, the fellow physicians, are surprised, shocked, saddened, confused, and frustrated at being faced with such a horrible occurrence and angry at our absolute powerlessness to ...
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G. Douglas Talbott, M.D. - 1924-2014

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G. Douglas Talbott, M.D. - 1924-2014
Dr. G. Douglas Talbott, M.D., the 90-year-old founder and original medical director of Atlanta, Georgia’s Talbott Recovery Campus, passed away on Saturday, Oct. 18, 2014, from pneumonia and cardiovascular disease. He was one of the most forceful voices in advocating the recognition of alcoholism as a disease....
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Tips From Dr. Bill W.

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Tips From Dr. Bill W.
During my stint in rehab, I missed my wife and family. While I knew they would be there for me when I returned, I wasn’t sure that the same would apply to my career. By the grace of God, it did. Many of us aren’t so fortunate, with our families or with our careers, but my experience with this program has convinced me that “doing the next right thing” will allow other doors to open, in my opinion through divine intervention...
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The Physician Lifeline - January 2015

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The Physician Lifeline - January 2015
IN THIS ISSUE: Tips from Dr. Bill W. Obituary: G. Douglas Talbott, MD 2014 Staff Presentations Avoiding Inappropriate Online Posts 2014 MPHP Contributors Power of Organized Medicine: Your Voice in Jefferson City Medical Society Membership & Your Practice Your Brain on Drugs
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Managing Medical Malpractice Stress by Louise Andrew, MD, JD and John-Henry Pfifferling, PhD
Although malpractice claims are a completely predictable hazard of medical practice in the 21st century, medical training rarely addresses, let alone confers immunity from the harmful effects of malpractice litigation. Here is what you need to know to begin to transform the experience...
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Assessment Tools for Sexual Boundaries

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Assessment Tools for Sexual Boundaries
The Federation of State Medical Boards regards physician sexual misconduct very strictly, saying that “...misconduct exploits the physician-patient relationship, is a violation of the public trust, and is often known to cause harm, both mentally and physically, to the patient....
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Is it Risky to Disclose Depression  on a Licensure Application? by Robert Bondurant, RN, LCSW
Executive Director, MPHP There appears to be uncertainty among some physicians as to whether or not to disclose a history of depression when applying for licensure. It is an important concern as it may also affect one’s decision aboutExecutive Director, MPHP There appears to be uncertainty among some physicians as to whether or not to disclose a history of depression when applying for licensure. It is an important concern as it may also affect one’s decision about...
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Identifying Suicide Risk by Nancy Morton, B.S.

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Identifying Suicide Risk by Nancy Morton, B.S.
Due to the recent suicides that have occurred in Missouri’s medical community in the last year, I have been eager to learn more about what can be done to prevent such tragic losses. During a recent AMA webinar on Suicide in Medical Education: The Stresses of Medical School and Residency Training, I was pleased to learn that...
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