America’s health care system is broken and no longer works.  Many practicing physicians are unhappy with the way insurance companies control medicine.  Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them.  Patients are frustrated with the exorbitant cost of prescription medicine.  They wonder why this system often doesn’t allow them to receive ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being ...

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My stomach had been in knots that morning. “Are you pregnant?” my classmate laughed after I returned to the gross anatomy lab for the second time after leaving for fresh air. “No,” I spat, dissection through fat and fascia, teasing out muscles from nerves. But, I wondered. After lab, I bought a pregnancy test. I began medical school in my late 20s, already having discussed with my husband appropriate times to start a family during ...

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With all this talk about medical student, resident, and fellow burnout, I thought we might take a break to discuss the small delights that sprinkle throughout medical training. This is not a “You should publish as a trainee” manifesto. It’s more of a DIY guide for those who are interested but can’t find the time or the mentor. And after a decade of rejected manuscripts, unfortunately, I’ve got ...

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Years ago, after I suffered a deep personal loss, my doctor prescribed Prozac, and I joined the millions of Americans who have taken an antidepressant. A few weeks later, I had my first panic attack — heart racing, sweating profusely, gasping for breath — sensations of terror normally reserved for life-threatening events. Attacks continued every half-hour and were so incapacitating that I could not even leave my house. My doctors ...

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My car says it’s 2:10 a.m., 17 degrees. I just left my warm bed — and snoring husband — threw on scrubs and my contact lenses and quickly brushed my teeth and hair. I’m shivering as the car warms up and I hear the crunch of the snow as the car rolls out of the driveway. I’m the first one out on the fresh snow, and it glistens in the ...

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In the United States, the patent protection process — as it relates to the drug industry — has been distorted by the political system, intense lobbying and large campaign contributions. The result has been pricing contrary to the greater good of the nation. Patents originated in ancient Greece. This legal protection assumed greater importance in 15th-Century Venice as a means to protect the nation-state’s glassblowing industry. The first patent granted in ...

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When we think of pollution, we think of our planet: stripped forests paved asphalt black, sterile red rivers, brown-gray skies and creeping slums over once virgin land. We imagine massive dumps of civilized waste, the extermination of species and temperatures which bake the earth like a neglected oven. We mourn the global home in which we live, neglected, abused, in ruin. Do we ever think about ourselves? That is one of ...

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My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are ...

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A fairly recent article in the Journal of Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students. It is sobering because it describes the potential harm that can come from it — harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything. "Overdiagnosis" is the term the authors ...

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Why would a well-respected, venerable health care organization adopt a soft and squishy approach -- tracking disrespect and other forms of emotional harm -- to monitor its performance? In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has ...

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STAT_Logo We have two ears and one mouth so we can listen twice as much as we speak,” said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. If you watch doctors — and many researchers do — they speak more than listen. Studies have shown that doctors interrupt or redirect patients within the first ...

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In these strange days of unsure future health care policies, shrinking budgets, and significant belt-tightening, as we look for ways to improve access for our patients, we need to reevaluate how we to get them into care, making sure we see them in a timely and efficient manner. We have always said that in this topsy-turvy time, in the crazy state of health care, what we really need is more primary ...

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The news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news. Mimi’s case was far from unique. Each year in the ...

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A recent issue of the Journal of the American Medical Association (JAMA) reads like an expose. Well, at least three of the research articles do. So exciting! I don't want medicine — my field — to be ethically unsavory, but it is sometimes. It makes me proud to see that it polices itself and that such information is published in a high profile journal. The first article ...

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My colleague, Dr. L.T. Kim, was off this week and I covered for him. On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons. I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency ...

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I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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The boom in telemedicine is here, and understandably so.  The “consumer” is in control now, and they sure don’t want to be “patient” anymore.  When Americans want care, they want it cheap, and they want it now.   Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago.  What savvy health care administrator doesn’t see numbers like that and get dollar signs in ...

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It's Match Day.  Standing with my medical school class in the lobby of our medical education center, there is a palpable energy. It had been a long journey. After reluctantly leaving CA for NY I had finally completed four grueling years. The entire time I was laser focused on doing well enough to make it back to California. The four years came and went in a flash, and without hesitation, ...

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I was raised in a family that hates taxes. Not hates taxes as in, “Gosh, it’s too bad such a high percentage of my paycheck goes to the government.” More like: “How dare the government steal my hard-earned money and give it to undeserving moochers?” (Is there such a thing as a deserving moocher? Sorry, I digress.) The origins of this anti-tax sentiment are deeply ideological, steeped in a frothy mix ...

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