In recent months, Silicon Valley has surpassed Hollywood as America’s home for high-profile split ups. Last month, computer security giant Symantec announced its intentions to split in two. And three days before that, HP announced plans to divide up into parts. In September, eBay announced its intention to spin off PayPal. With enough twists and turns to fill a screenplay, the tech industry’s recent split-up saga raises a couple of ...

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Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. I have used this technique with great ...

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We need to start skin cancer prevention with our children The numbers about skin cancer incidence and costs in the United States are worse than anyone expected. That's the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute. The researchers took a look at the number of skin cancers ...

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Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. A slender, middle aged man, ...

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We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast. Two recent reports demonstrate how ineffective this program is and how much ...

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I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time. I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of coats (it’s cold these days, but varying degrees of ...

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Top stories in health and medicine, November 25, 2014From MedPage Today:

  1. FDA Advisers Tackle Epidural Steroid Shots. An FDA advisory committee is meeting Monday and Tuesday to discuss adverse neurologic effects following the use of epidural steroid injections for pain management.
  2. FDA Stiffens Warning on Power Morcellators. The FDA has warned against using power morcellators during hysterectomy or treatment of ...

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Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75: An argument that society and families -- and you -- will be better off if nature takes its course swiftly and promptly."  As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest -- and that it ...

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A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system ...

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I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks. Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero. Stupidity, though, was ...

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I understand that for some, digital health still might be a bitter pill, but the promise of techno-medical mumbo jumbo is bold and transformative. That being said, in my opinion, the “secret sauce” to digital health might be a bit outside the conventional “drug development” methodology -- both in logistics and psychology. Therefore, I thought it would be fun to take a page out of IBM’s Watson playbook. IBM recently used “cognitive ...

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The costs of fertility preservation in cancer treatment I have fertility on my mind -- and it’s definitely not personal. And it’s really fertility preservation that has me thinking. I recently completed the manuscript of my 10th book -- a text for oncology care providers about the provision of psychosocial care to young adults with cancer . Writing the book was at times frustrating due to the paucity of research and ...

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I recently began a rotation at the hospital as one of the night float interns. As part of this responsibility, I manage the care for approximately fifty patients each night. Day after day, I perform the same routine in preparation for the night ahead: Grab my stethoscope and pager, claim one of the code pagers, pick up a time sheet to fill in the nightly team to-do’s and mentally prepare ...

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Top stories in health and medicine, November 24, 2014From MedPage Today:

  1. Does an IUD and Family History Boost RA Risk? Current use of an intrauterine device (IUD) was associated with an important biomarker of future rheumatoid arthritis risk among women with a family history of the disease.
  2. Pricey Generics Draw Senate Scrutiny. Robert Frankil, RPh, was dismayed when a customer ...

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It didn’t seem like my college-age patient Quincy had any idea what was in store when I entered the exam room. “Hi Dr. Rifkin,” he said with a warm smile as I sat next to him. Quincy (not his real name) had been my pediatric patient for years. I didn’t delay. “Hi Quincy. I’m afraid I have some terrible news. Your lab work came back -- you’re HIV-positive.” His head went back slightly. ...

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Four months ago, a 44-year-old woman was referred to me by her audiologist and ENT for acute deafness of the right ear. She is a healthy woman without any past medical history and was not on any medication. Her otolaryngologist (ENT) could not find any physical reason for the patient’s acute unilateral deafness, including a negative CT scan. She was being referred to me to determine if there was an ...

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The policy known as meaningful use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers. Because I believe that meaningful use is now doing more harm than good, I ...

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Since the first day of medical school, I was in breathless anticipation of my third year. I came to Harvard with a background in creative writing and the big draw of medicine for me lay in its compendium of human stories. In college, I volunteered at local hospitals where my primary responsibility was to go knock on patients’ doors and keep them company for a little while. This was awesome. Few ...

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Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that's more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now situated in the ED; a space powered by a ...

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What will future of medicine look like? Start here.What will future of medicine look like? Start here. Excerpts from The Guide to the Future of Medicine. Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not ...

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