Infants with a first-degree relative (parent or sibling) with celiac disease, and who carry an at-risk (DQ2 or DQ8) gene, have a higher risk of developing the autoimmune disorder triggered by gluten-containing foods. Many parents, especially those with a family history of celiac disease, are understandably nervous about introducing gluten into their child’s diet. They wonder whether there is an ideal time to introduce gluten, if they can prevent celiac ...

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Burnout syndrome is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress. I burned out early. Right out of fellowship, I no longer wanted to be a doctor. The grueling hours, my grumpy co-workers, and distant patient engagements left me totally exhausted. However, over the course of a year, I was able to rediscover my passion for medicine. Some tactics were deliberate, mindful behaviors, some occurred ...

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“I was surprised when the emergency doctor at Cityside Hospital said he was going to call you to discuss my case," Farmer Carr said when I saw him today. “I figured you’d be asleep at that hour.” I smiled as I recalled the cell phone call that had come in at 9:30 the night I had sent him back to the hospital for a reassessment. “No, I was sitting in my camping ...

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The redefinition of a potentially functioning medical system in which each individual is able to utilize financially non-prohibitive care into a disjointed balkanized realm of income-based insurance tribes is aided by the protean definitions of the political buzzword “access.”  Access to medical care does not entail the ability to reliably obtain medical care much as medical insurance reform is not, in point of fact, healthcare reform.  Regardless, the conflation of ...

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Last week I finally got around to watching La La Land. As a fan of musicals, I had wanted to see it for quite some time, and before I stepped into the theater, I didn’t know what it was about nor what kinds of reviews it had been getting. Spoiler alert: Don’t read on if you haven’t seen it and intend to watch it (and I’ve never told anybody before ...

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This week is Physicians Week, and this is one in a series of interviews with members of the physician community that are bringing a variety of ideas and networks together in order to improve the relationships between physicians and between physicians and their patients. Dr. Marion Mass is a pediatrician in Philadelphia and a board member of a physician advocacy group, a large physicians-only network that started as a group on ...

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Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR.  Nonetheless, it is not really about my needs.  I am talking, of course, about why I give patients my cell phone number. It is printed ...

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It sounds great, almost too good to be true: Coverage for all with lower costs, a broad choice of providers, and minimal paperwork. The problem is that it won’t work. For more than half a century, advocates for a government-run, single-payer approach to health care coverage have touted its potential. With debate over the Affordable Care Act heating up by the day, progressives, both at the state and federal levels are now ...

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His voice was gruff and his expression surly. "I don't want any more medications." His face was indented by deep clefts, remnants of eight decades of life hard lived. His tone was commanding and certain. I knew that he was fond of me, but I could feel his patience slipping. He neither asked about nor accepted his diagnosis of heart failure. I could tell him till I was blue (or he was ...

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This week is Physicians Week, and this is one in a series of interviews with members of the physician community that are bringing a variety of ideas and networks together in order to improve the relationships between physicians and between physicians and their patients. Dr. Kim Jackson founded a large network of physicians and future physicians that started as a group on Facebook. As patients lamented increasing costs in health coverage ...

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Despite living in Michigan for over 30 years, my cold hands disclose my Southern California origin. As a physician, these cold hands have touched many lives. For my pregnant patients, they usually sigh with relief as I touch their bellies, the coolness of my hands offering them respite from the inferno growing inside them. They smile when I tell them I can feel their baby squirming and how it is ...

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My husband and I, both anesthesiologists, enjoy our Sunday mornings together -- coffee, the New York Times, a leisurely breakfast. No rush to arrive in the operating room before many people are even awake. Today, though, seeing reporter Jan Hoffman’s front-page article in the Times -- “Staying Awake for Your Surgery?” -- was enough to take the sparkle out of the sugar. Her article on how much better it ...

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I did a second stint on a talk radio a few weeks ago which I really enjoyed.  The callers represent a genuine, down-to-earth view of the reality of connected health adoption.  The first time around, most callers were cautionary, raising concerns about data security and wondering about physician endorsement.  This time the theme that spontaneously emerged was one of people telling stories from the heart, about loved ones ...

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Attention all nurses, nurse practitioners, physician assistants, midwives, doctors and anyone else in health care: Here are the top 10 warning signs that it is time to quit your job. The first three are mine. The rest are from colleagues. If you recognize anything on this list, please quit your job. 10. You feel nauseated when you see your clinic logo. You alter your commute to avoid streets with your clinic’s ...

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Transparency -- including price, quality, and effectiveness of medical services-- is a vital component to lowering costs and improving outcomes.  However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in vain.  The single best way of reducing costs while not worsening health outcomes is to redistribute resources from less cost-effective health services to more cost-effective ones.  Americans are extremely uncomfortable ...

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When Louisiana resident Andrea Mongler wrote to her senator, Bill Cassidy, in support of the Affordable Care Act, she wasn’t surprised to get an email back detailing the law’s faults. Cassidy, a Republican who is also a physician, has been a vocal critic. “Obamacare” he wrote in January, “does not lower costs or improve quality, but rather it raises taxes and allows a presidentially handpicked ‘Health Landing Pages Choices Commissioner’ ...

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When I go to work, I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern lifeline. I take lunch. I carry a pen, flashlight and pocket knife. On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years ...

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The phones, the phones, the phones. Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can't lick, a continual thorn in the side of our practice, something that's hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without ...

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My cohort graduated from our psychiatry residency almost ten years ago. The level of frustration and disappointment we’ve all experienced within the past two years is striking. Some have taken leadership roles, only to relinquish them because of fatigue from fruitless discussions with administrators. Others have tried to alert senior managers about dangerous and irresponsible clinical practices. Their efforts were unsuccessful because concerns about finances trumped concerns about clinical services. With ...

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I grew up in the United Kingdom and have friends and family who rely on the National Health Service. I’ve written previously how I believe that, despite the idea of a completely free at the point of use health care system sounding very noble -- and there are certainly many great things about the NHS -- it’s not a model that has been copied in any other country. As someone who ...

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