Hepatitis C is one of the most common chronic infectious illnesses in the U.S. today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis.  Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation.  In the last year,  a new drug class has entered the market and can produce cure rates in excess of 90 percent. These ...

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Practicing physicians like me rely on up scientific medical journals to keep us current on medical developments. We learn about new treatments for old diseases. New diagnostic tests are presented as alternatives to existing methods. Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which ...

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We physicians have long labored under the belief that if we provide objective data about the safety and efficacy of vaccines we can change anti-vaxxers’ minds. But political scientist Brendan Nyhan, Ph.D. has shown that directly addressing patients’ concerns about vaccines does little to change their decision to immunize. And he’s probably right. Other research examining the effects of education on strongly held personal beliefs have shown the same ...

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Let's take a moment to consider what makes a terrific nurse. First, by way of gathering information, let's consider the health care industry's present views on excellence in nursing.  Let's think about how this conception of excellence in nursing aligns with our own perspectives. In a recent Atlantic article, titled "The Problem with Satisfied Patients," Alexandra Robbins writes about the economic incentive hospitals face to improve patient satisfaction scores.  This ...

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A response to "You’re a medical student. And it’s so obvious why." We don’t even have to ask, and we can tell by the bags under your eyes. It’s so obvious that you are a medical student. References in every pocket of your short white coat, pulling down on your shoulders until you hunch over. You force yourself to stand up straight when the attending comes around. We’ve seen you at all ...

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It was May 13th, 2012. Mother’s Day.  My wife, Cyrena, was having an incredibly difficult pregnancy. She had pounding headaches, blurred vision, and searing pain throughout her body. As a matter of fact, she had been in and out of the hospital for the last two weeks. Our tiny daughter was only developed 23 weeks in gestation. Her due date was September 9th, 2012. Unfortunately, my wife had extremely early ...

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Physicians are struggling to adapt to a sea change in the health care delivery system. Solo physician practices are disappearing, small group practices are merging to become larger, and large group practices are being acquired by hospitals and integrated delivery systems. All of this is occurring in a milieu of decreased fee-for-service reimbursement from government and private insurers, bundled payments and pay for performance, increased levels of student loan debt, ...

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Following the recession, the Obama administration sought shovel-ready projects. One unlikely shovel-wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 percent of the stimulus towards digitizing medical records. Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between ...

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A continuing series on physician online reputation.   For more KevinMD minutes, please visit my YouTube channel. What do you need to do before starting your online presence with social media? They are your bio and your head shot. Together, they will be your first impression to patients who find you on the web. First, let's talk about your head shot. Make sure it's a high resolution image. ...

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During my family medicine rotation, my very first clinical clerkship of medical school, I received the assignment of making a home visit to one of my preceptor’s patients -- a man I will call Mr. Jones. Mr. Jones had congestive heart failure, COPD, and a barrage of other chronic health problems. He was a pleasant gentleman, but had a low level of health literacy and had been doing a poor job ...

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I have spent 32 years working in hospitals and the last 16 running them.  Hospitals are created for the benefit of the community, a place where people go when they are acutely Ill, injured or have a complex condition that eludes quick diagnosis and treatment.  Hospitals historically provided primarily inpatient care and comprehensive diagnostic and treatment facilities for patients. It took a major snowstorm -- one of many we endured this ...

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After four years working as a child and adolescent psychiatrist in Brooklyn treating the underserved, I decided it was time to dedicate myself fully to my growing private practice. Functioning solely as an out of network provider in private practice, as expected, my clientele grossly changed. Unlike my hospital patients, a majority of my patients are upper class to wealthy. Finances are not concerns or stressors. Wealth does not predict a decrease ...

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medpagetodayFrom MedPage Today:

  1. Sleep Apnea Linked to Depression in Men. Obstructive sleep apnea (OSA) is associated with an increased risk of depression in men.
  2. Tapering Asthma Meds Saves Money in Stable Patients. Reducing asthma medications in stable patients led to cost savings without increasing utilization of other asthma resources.
  3. Poor ...

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One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured. Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program ...

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A couple of years ago, my clinical practice (Dermatology Associates at Massachusetts General Hospital) began sending patients a bill when they did not show up for an appointment. Dentists do this with some frequency, but it’s unusual for a physician practice to do it. Our reasoning was that we have many folks who insist they need to be seen right away and, despite a large, busy practice (we see more ...

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Enough already about Dr. Oz. Whichever side you happen to be on, we might collectively acknowledge that much of the noise being made about what is, at worst, a symptom, is itself an indication of a culture-wide disease. The fate of Ozymandias comes to mind. Science is Ozymandias. Soundbites are the ruin of it. In the case of the Oz saga, it's abundantly clear to anyone who actually
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The buzzwords many use in medicine today are "personalized," "individualized," or "targeted." Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions to unique patient characteristics, such as genomic data. (The White House's Precision Medicine Initiative is an example of this kind of thinking.) Although I am skeptical that big data-driven genetic ...

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As I have been known to say on this blog once or twice before, one of my favorite things about being a developmental pediatrician is the opportunity to follow the children I see for initial diagnostic evaluation over the long term. New research presented at the Pediatric Academic Societies conference makes me especially hopeful. When our clinical ...

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There he stood at our beach party, the family doctor I grew up admiring. I timidly approached his circle of friends to announce I had gotten into medical school and would start in the fall. He stopped to attention. His friends stood watching. I couldn’t conceal my smile. I thought, “He is going to be so excited for me!” “Get out now.” Before I could respond, he continued. “The profession isn’t ...

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medpagetodayFrom MedPage Today:

  1. Overactive Bladder May Set Seniors Up for a Fall. A diagnosis of overactive bladder (OAB) significantly increased the risk of falls among a Medicare population.
  2. IBS: Peppermint Oil May Be a Treatment Option. A slow-release peppermint oil (IBgard) appeared to significantly reduce severe abdominal symptoms of irritable bowel syndrome ...

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