As a medical student, I strongly support vaccination.  It works, it's safe, and it doesn't cause autism.  But I also understand why many parents don't believe me and the medical community when we beg them to vaccinate their kids. Medicine has come a long way from "do no harm."  Now we talk about risks and benefits: and none of our tests, medicines, or procedures are without risks.  Increasingly, pharmaceutical companies have ...

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I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice.  This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most ...

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Cancer patients depend on denial.  Without its protection, we would be overwhelmed by terror.  Denial filters and slows bad news, so we can digest reality in the merciful morsels; thus, we cope.  Without denial, we would shut down, withdraw, and lose hope; healing would not be possible.  However, if we do not move beyond denial, accept the diagnosis and loss, make a plan, we die. Allen, a 43-year-old man, came to ...

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blueandblackdress2-770x457 My mother-in-law texted me about The Dress, random friends are blowing up my inbox, and the nurses in the emergency department were huddled around the computer at 2 a.m. debating the color of the dress. Everyone in the world seems to be wondering what color the dress really is and why. The best way to find the answer to such questions is to find ...

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Some people who argue against vaccinations claim that vaccine policies infringe on their “rights” -- their rights, as parents, to make medical decisions for their children. It’s a scary, misleading, and chilling message. We need to be careful about where one person’s rights end and the next person’s rights begin. We need to remember that children (their children, and your children too) have rights of their own. For example, Dr. Bob ...

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I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues. We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor. It has taken us a long time to get here. Let’s do some math. 4 years of college + 4 years of ...

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Recently I wrote about the problems with maintenance of certification requirements.  One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other ...

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medpagetodayFrom MedPage Today:

  1. Mom's, Kid's Fructose Intake Linked to Asthma. A child's risk of asthma increased significantly with maternal fructose intake during pregnancy.
  2. Mixed Outcomes in Pregnancy After Weight-Loss Surgery. Women with a history of bariatric surgery who later gave birth faced both benefits and risks including a lower risk for gestational ...

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Assigning patients to doctors. Who still does this? We don’t assign hungry people to restaurants, hairy people to barbers, or passengers to airlines. Even State Farm allows me to choose between Maaco or my local chop shop every time I crash my car. We do assign kids to teachers, but still, I don’t need too many analogies to tell me that assigning patients to doctors is a bad idea! The average U.S. ...

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Recently, Ohio became the 20th state to pass a law mandating that hospitals and clinics performing mammography screening to notify a patient in writing if results suggest something known as "dense breast tissue."   Standard mammography creates a 2-D image of breast tissue.  In general, this is sufficient for screening purposes.  However, especially in younger patients, the presence of dense breast parenchyma can lead to higher false negative readings and ...

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The high cost of health care in the United States in part relates to how clinicians are paid. Performing expensive and often risky procedures simply pays better than engaging patients in a shared decision-making conversation. Shared decision-making (SDM) is a process where clinicians and patients educate each other about treatment options, risks and benefits, and preferences, and then they decide on the best approach together. Patient decision aids can assist ...

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Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

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As medical librarians, we’re certainly the first to say that PubMed is a superb database, elegantly crafted at the National Library of Medicine to do fast and efficient searches for almost all medical and health subjects. Much of the power of PubMed is that it makes it possible to search broad subjects easily. When the user searches “cancer,” for example, PubMed quickly finds thousands of citations on all types of ...

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I sometimes think doctors forget what it’s like to be patients. But I’ve been there, and I know how frustrating and scary it can be. I remember one night, I was lying in a hospital bed, resting peacefully. I heard a noise and opened my eyes to a room full of chaos. Nurses everywhere. A crash cart. Someone holding paddles. I tried to speak, but couldn’t. And then I got it out: “Please don’t.” Here’s my story: Before ...

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medpagetodayFrom MedPage Today:

  1. Studies Cement Value of HIV Prophylaxis. re-exposure prophylaxis (PrEP) with a single pill prevented HIV infection among more than 85% of two groups of men who have sex with men.
  2. NSAIDs: A Risky Addition to Post-MI Antithrombotics. Adding a non-steroidal anti-inflammatory drug (NSAID) to antithrombotic therapy after a heart ...

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Help, I need somebody! Help, not just anybody! Help, you know I need someone, help! - The Beatles We are all here on earth to help each other; what on earth the others are here for I don’t know.  - W. H. Auden “Help the doctor!” I’m sure most surgeons have heard this exasperated statement at some point in the operating room. It is said with that special mix of frustration, irritation, and sarcasm, usually when things aren’t going ...

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Physician burnout has been previously described as heartbreaking, and this may be an understatement.  The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days. Unfortunately, these topics are still not formally taught in American medical schools. As students, we really do not know ...

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For years, policy experts have been predicting the end of fee-for-service.  Yet it can be said of fee-for-service that, like Mark Twain’s alleged demise, reports of its death have been greatly exaggerated. (Actually, this is an often-used misrepresentation of what Twain actually said. After the New York Herald incorrectly reported that he was “grievously ill and possibly dying,” an “amused” Mark Twain wrote that “the report of my death has been ...

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Once the 2008 economic spiral began and, unemployment escalated with wallets and purses zipped closed, causes were not initially recognized. Since then, the causal details of this downturn were ferreted out pinpointing emanation from Wall Street banks. Public discontent demanding change has been ignored allowing potential for recurrence. Why? Business has influenced legislators swaying their vote as they filled campaign coffers. In the same way, business has taken over health care. For those ...

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Two problems loom large over the American medical care system. First, we spend outrageous amounts of money on health care, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many health care providers sued by too many patients for too little reason. Many experts have pointed out that these problems are two sides of the same coin. ...

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