It took me until 2010 to buy an iPhone and in just a few years, I’ve become so dependent on it, without fail, I will always make a U-turn to make sure it’s with me -- my smartphone is essentially a new limb for me. I know I’m not alone. Most did not predict the rocket speed adoption and transformative power of modern smartphones when the iPhone launched in 2007. But, in ...

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Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010.  Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act.  Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure. But is consolidation the clear-cut answer? Here are 4 reasons bigger actually may not be better for all hospitals: 1. Disparate ...

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There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere. Another excellent article in the Wall Street Journal last week extensively discussed the factors behind poor job satisfaction within our profession. The ...

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I admittedly spent a good portion of the fourth year of medical school dreading internship. A year where I was expected to suddenly be a doctor and to have all the answers. A year where I would work long hours and carry several pagers at one time. I come to you in blog form to inform you of some of the truths about internship. I have been an intern in ...

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It is estimated that approximately 14 percent of U.S. physicians in training are depressed and another 10 percent experience suicidal ideation.  Some 400 U.S. physicians take their own lives each year.  Hampering efforts to deal with such problems is the stigma associated with them.  I knew a top medical student who was reluctant to seek mental health care in part because he feared doing so would tarnish his record.  Earlier ...

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Top stories in health and medicine, December 18, 2014From MedPage Today:

  1. OmniCarb Study: Cutting Carbs No Silver Bullet. Overweight and obese people who followed a low glycemic index diet in the context of an overall DASH-type diet had no greater improvements in insulin sensitivity, lipid levels or systolic blood pressure compared to study subjects who ate high glycemic index foods.

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I do not know about you, but I get confused about the Heisenberg uncertainty principle.  Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement.  However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits.  If you measure one thing, such ...

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In the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; "Healthcare post-Obamacare" or "Radiology in the new era." Talks warning us that we were exiting the ...

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She was absolutely perfect.  She had ten perfect fingers and ten perfect toes.  Her eyes were wide and curious and drew you in fondly. She was absolutely perfect everywhere -- everywhere except for her nose and mouth. She was born in 1959 with a unilateral complete cheiloschisis and palatoschisis, more commonly known as a cleft lip and palate.  Where her perfect, beautiful nose should have been was an empty, gaping ...

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Old age is no place for sissies. -Bette Davis “I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!” She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had ...

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In just the past six months months we, the medical community, have been challenged by questions regarding the torture report, #ICantBreathe and #WhiteCoatsForBlackLives hashtags, Ebola research and treatment, the ALS ice bucket challenge, deaths of Brittany Maynard and Joan Rivers, and the Hobby Lobby case.  What these events have in common are not their scientific or molecular underpinnings, but rather their push for us to reflect on the current state ...

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Today was (almost) the last straw. If you've read this column before, you've listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care. This one today takes the cake. Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, ...

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Top stories in health and medicine, December 17, 2014From MedPage Today:

  1. Gene Test Has Promise for Nailing DCIS Recurrence Risk. A multigene panel predicted recurrence risk in ductal carcinoma in situ (DCIS), according to a population-based study.
  2. Docs, Guns, and Smokes. One day in clinic, 2 years ago, a patient handed Adam Goldstein, MD, MPH, a request for a concealed ...

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She screamed when her boyfriend hugged her. Why? I was checking my email when it happened. My boyfriend had texted me saying that he was late arriving to the airport. So I stood outside with my suitcase behind me and clicked to an email from my mother. I didn’t notice until too late that someone had approached me, and I screamed when I saw a black man reach out to ...

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Unfortunately, measles is in the news again. Measles is a very contagious viral illness that causes a high fever, rash, cough, and a runny nose. Complications include pneumonia, brain inflammation and death. Prior to 1963 there were hundreds of thousands of measles cases in the U.S. annually, causing hundreds of deaths. In 1963 the measles vaccine was introduced, leading to an immediate decrease of measles cases in this country. In 2000 measles was ...

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The American hospital as we know it is in peril I appreciate the need for physicians and others to sleep.  I’ve spent a great deal of my career awake in the wee hours.  In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians.  But I fear we’re all wearing a little thin.  Because the emergency room has become ...

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What I learned from the next generation of doctors “So this is Christmas, and what have you done?” John Lennon sang from my nightstand, waking me out of a deep slumber. Bleary-eyed, I pondered his question: What have I been doing all year? A decade ago, my conversations with my younger brother, went something like this: “Do anything but medicine for God’s sake, save your soul, man!” He’s now an emergency room doc. ...

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How to fix maintenance of certification: Heres what Id do There's a lot of angst when it comes to board recertification.  The general consensus is that doctors find the requirements onerous, while a more cynical segment calls the whole process a money-making operation for our professional societies and those that profit from recertification courses and materials. Cardiologist Wes Fisher has articulated the many criticisms against board recertification: "Does board recertification do ...

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After prostate cancer treatment: What about intimacy for men? I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first -- my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on ...

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Top stories in health and medicine, December 16, 2014From MedPage Today:

  1. Painful Hands, Hurting Hearts? Symptomatic osteoarthritis (OA) of the hands was associated with an elevated risk for coronary heart disease events, analysis of data from the Framingham Heart Study showed.
  2. Can Social Media Aid Public Health? Here's an angle Mark Zuckerberg has probably not yet mined: restaurant reviews and ...

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