I don't remember all of the details. It was the summer of 1990, sometime in the first 3 months of internship. I spent those months on the 11th floor of the VA Lakeside Medical Center (now the vacant lot just east of the hospital). The VA was familiar territory for me. I spent 3 months there as a third year student, also on the 11th Floor. 11 East, to be ...

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Lesson learned: Not everyone is crazyLesson learned: Not everyone is crazy An excerpt from The Spattered White Coat: Intense experiences which formed a young doctor. I'll never forget one of the first patients I interviewed. When I went to get him, I could see him sitting in the waiting room, looking around and scratching his arms repeatedly. He was a very ...

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Over the past 5 to 10 years, hospitals and physician offices have been in a mad dash to implement electronic health records (EHRs) in order to meet governmental regulatory requirements.  Now that most projects are either complete or well on their way, what are we doing with all of the data that EHRs promised to generate? From my experience as a physician at a large academic medical center with one of ...

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The best way to avoid the flu is spending the months from fall until spring in a solitary bunker, communicating with other people only electronically. The second best way is getting the flu vaccine. The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for everyone over 6 months who doesn’t have a specific contraindication to it. Because of the increasing number of different flu vaccines that are now ...

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The media has feasted on the recent release of data by the Center for Medicare and Medicaid Services (CMS) that details payments made by the pharmaceutical and device companies to hospitals and physicians in 2013. This was part of the the Physician Payments Sunshine Act (PPSA) -- also known as section 6002 of the Affordable Care Act (ACA) of 2010. What the media refuses to write is that these payments were ...

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I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today. Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a history of coronary disease and had an intracoronary stent ...

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Top stories in health and medicine, October 23, 2014From MedPage Today:

  1. Aortic Dissection Becoming Less Deadly. Aortic dissection survival has improved, particularly for patients getting surgical repair.
  2. Preparing for Ebola: Is New York City Ready? The hall was packed, the speakers were primed, and the message to thousands of healthcare workers gathered here today was simple: Ebola will not sneak ...

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After listening to a lecture, third-year students at the Harvard School of Dental Medicine were surveyed about distractions by electronic devices and given a 12-question quiz. Although 65% of the students admitted to having been distracted by emails, Facebook, and/or texting during the lecture, distracted students had an average score of 9.85 correct compared to 10.444 students who said they weren't distracted. The difference was not significant, p = 0.652. In ...

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If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place. What might be their unique insights? What will be their prescriptions? One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil ...

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One catch phrase in health care reform is cost-effectiveness.  To paraphrase, this label means that a medical treatment is worth the price.  For example, influenza vaccine, or flu shot, is effective in reducing the risk of influenza infection.  If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine. Society could not ...

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As I finish my post-operative care routine for my 9-day-old patient, I notice that the cerebral oximetry machine is not picking up a strong signal. Despite troubleshooting, I am unable to figure out how to fix the problem, and I head to the Pixus to get a new sensor. Unfortunately, this one does not work either, and we must use a smaller sensor to pick up an adequate signal on ...

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Recently, my eldest son came home from college for a couple of days. Our home was in perfect harmony and rhythm. The duets (and quartets, if you count us parents) that had played over the prior month-and-a-half were once again trios and quintets. Five or six hands on the piano at a time. The clear brass joining in again with the bright woodwind and the deep bass. The voices in ...

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Pamela Wible: A eulogy to her father I believe we choose our parents before we are born. I hit the jackpot. I picked an unlikely pair -- a radical feminist and a guy named Ted Krouse. Mom wasn’t home much (she was finishing up her psychiatry residency) so I became head of the household. Dad always kowtowed to the strongest woman in the room. I was two at the ...

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Top stories in health and medicine, October 22, 2014From MedPage Today:

  1. Office Visits Linked to National HTN Control. While hypertension treatment rates have risen over the past decade, but control of hypertension may have plateaued, according to a national study that suggested regular office visits as a key factor.
  2. A Youthful Approach to Breast Cancer Prevention. Most of us are ...

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Did you know that your digestive tract contains over 400 different types of bacteria? This complex ecosystem is called intestinal microflora. The concentration of bacteria in the gastrointestinal tract increases dramatically moving from the stomach towards the colon. In humans, the intestinal microflora is vital in many important functions including digestion of nutrients and prevention of infection. Disruption of the “normal flora” can lead to many problems including diarrhea, bloating, ...

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Ebola is everywhere. Turn on the television, and you will see the headlines. “Ebola in America.” Or, “Hospital worker who handled Ebola is on cruise.” And then there is the “Ebola fears prompt parents to keep children home from school.” The headlines go on. Go onto Facebook or Twitter, and you will see Ebola as the most viewed article, or the most tweeted topic. Ebola is everywhere. Ebola is incredibly infectious. Ebola is ...

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Not too long ago I suggested hospice to a patient who had progressive cancer, although she likely had months to live.  “I don’t think it is time,” she replied, “hospice is for morphine.” “That is not how I see hospice,” I replied, “I think hospice is about getting the best care and support, even if there is no real treatment for the disease.  It is about living well, maybe better. Even ...

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While driving to work, I listened to Mike and Mike (a radio sports talk show). Mike Greenberg made a wonderful point about his job. He described what they do as “professional over-reactors.” They take every game and extrapolate, sometimes irrationally, about the implications of that game. Does this remind you of health reporting? A study appears in a serious medical journal, and the press “blows it up” as the next great advance. ...

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What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps. It was the swastika tattoo next to it. “Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain medication. The nurse will update your tetanus shot. But ...

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A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed ...

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