My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

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Part of a series. Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.”  Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it's every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will ...

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Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly ...

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Having been born and raised in the United States, I have become accustomed to the reputation of the U.S. as being ahead of the curve in terms of advances in numerous fields including medicine, and the research that we produce in these fields strongly backs up this claim. I have been reminded of this over the past few days while following coverage of the Ebola outbreak in West Africa. American health ...

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Many organizations cook up recommendations for the number of fruit and vegetable servings you should eat every day.  Well known examples include the USDA which suggests two cups of fruit and two and a half cups of vegetables daily (approximately 8 to 10 servings), the American Heart Association which recommends 8 to 10 and the Harvard School of Public Health suggests somewhere between five and 13 servings of fruit and ...

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The Health Information Technology for Economic and Clinical Health Act of 2009 committed to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care while promising dramatic improvements in quality, efficiency and safety.  Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment. First, EHRs were designed to document the provision of health care ...

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Deciphering hospital bills is not for the faint of heartDeciphering hospital bills is not for the faint of heart An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry. Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered when comparing notes with a friend, there’s another puzzle: the huge ...

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You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital. Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abbey. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought ...

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Cholesterol is bad. Cholesterol is an essential building block for important hormones. Eggs are bad. Eggs are a complete protein food. Salt is bad. Salt is essential for life. High blood pressure kills people. No blood pressure defines death. High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks. Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems. Too little vitamin B12 causes nerve damage. Too ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is reevaluated during a follow-up examination for a wrist fracture and anemia. The patient is otherwise asymptomatic. He was treated in the emergency department 2 weeks ago after he slipped in his driveway and sustained a right wrist fracture; mild iron deficiency anemia was detected at that time. He ...

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How to be a great health care administrator In no other field is unity and collaboration between administrators and frontline staff more important than in health care. Unfortunately my own experience is that the disconnect and mistrust, especially from doctors and nurses, towards hospital administration is growing larger all the time. Let me start off by saying that I have intimate experience of both sides of the divide. Obviously as ...

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A few days ago a colleague of mine was inching south through the mother of all traffic jams: 60 straight miles of construction work on I-95 just south Washington, DC. The three-lane highway was jammed. Route 1, which runs parallel to I-95 was also jammed. Cars were stalled in the middle of the highway having run out of gas from waiting so long. He looked at the map on his phone ...

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“We lost our regular doctor with Obamacare, so now we have to see you.” I routinely ask my new patients how they heard about our pediatric office, and this is the answer I dread most. My pediatric practice is a very nice and modern private office, and in my opinion, full of excellent physicians. I entrust my own children’s care to my partners. But none of that matters when you’re the rebound doctor, the ...

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"Dr. Sevilla, I have a question for you," a patient asked me this week. "I'm going to tell you something, but I DO NOT want it put in the chart." Hmm, I asked myself, can I really do that? It's the patient's wish, right? The patient went on to tell me that she heard about this week's story about a hospital network being hacked and 4.5 million records being stolen. ...

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“No Ebola in West Point” was the reported cry of the local crowd that attacked a quarantine center and freed patients in a township near Liberia’s capital.  Their words signaled skepticism toward the Liberian government and disbelief in the spread of the Ebola virus. The cries of the crowd were met with cries of shock and dismay on Twitter and other social media. “Are they crazy or just stupid?” one ...

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Check out the prices for nebulizer solutions of albuterol and budesonide (generic Pulmicort). They are totally affordable. $4 for a month for albuterol. $14 for a month for budesonide respules. Pulmicort respules used to be very expensive. Now even the branded budesonide is  less than 10% of a monthly cable bill. Then check out the prices of inhaled steroids delivered through meter dose inhaler (MDI) or dry powder inhaler (DPI). These ...

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Top stories in health and medicine, August 29, 2014From MedPage Today:

  1. Thyroid Problems May Up BP Risks in Pregnancy. Women with hyperthyroidism and even high-normal free T4 during early pregnancy had an elevated risk for developing hypertensive disorders.
  2. Study Questions Surveillance Colonoscopy. Removal of adenomatous polyps -- without follow-up surveillance colonoscopy -- led to a colorectal-cancer mortality similar to that ...

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In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question. As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming ...

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