When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why.  We try to learn if there’s anything we could have done better and what we should do next time. It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference.  It was ...

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As a medical student, it’s difficult to face a situation where everything possible is done for a patient, yet due to circumstances (seemingly) beyond our control, the risk of future harm remains uncomfortably certain. The majority of our medical school learning focuses on how to cure illness; unfortunately we’re not always taught how to deal with the real world issues that face our patients and that threaten the medicine we ...

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After serious self reflection, is there redemption for Dr. Oz? Recently, Dr. Oz has come under scrutiny for his information on a number supplements that he alleges help with weight loss. Over the past 2 years, he has presented information about 3 diet supplements: green coffee extract, raspberry ketones and garcinia cambogia. After reviewing the available information, I can not agree that there is compelling scientific information to recommend ...

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This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here's my answer to the question, "What should I look for in a good family medicine (FM) residency program?" It's FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that's in line with the Accreditation ...

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At a crowded townhall meeting in 1959, an elderly woman stepped up to the microphone and spoke to a panel of senators. "I am not worried for my son's time," she began. "He is 35, and I am sure he will face a better future when his time comes to retire. But what is to be done for those of us who need help right now?" This was one of a ...

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Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine. But in today’s practice of medicine, that’s not enough. Physicians, ...

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This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,"Sliver of Medicare Doctors Get Big Share of Payout." Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization ...

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We've all come to expect our doctors to run late for appointments. I’m a doctor, and when I go to see my doctor, I expect the same. I bring my laptop or something to read to bide the time. Waiting makes us feel like we or our time isn’t valued, and doctors know this. So why is it so hard for doctors, including myself, to stay on time?   Most doctors have ...

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Though there have been notable exceptions, digital health has often proved a slow sell to the medical establishment. The failures of Google Health and HealthVault to gain traction, for example, underscore the challenges of breaking into the workflow of doctors. Yet over the past month, three technology giants have, in the form of a series of launches, given an endorsement that digital health will be one of the next important technological ...

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Top stories in health and medicine, July 30, 2014From MedPage Today:

  1. Do Decision Aids Help Patients Make Difficult Choices? Decision aids designed to help patients make general healthcare choices, such as selecting a treatment location, provide some help, but condition-specific aids may provide the most useful information for patients and families.
  2. Asbestos Revisited: A New Autoimmune Disease? In the small ...

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The old adage “time is money” holds true, especially in health care. Apparently the medicine time crunch spans two midnights. In October 2013, Medicare enacted a provision that changed coverage for hospitalized patients. The “two-midnight rule” states that a patient will not be covered as an inpatient unless their hospital stay is expected to cross two midnights. The end result is that many seniors are placed under observation, even if they stay ...

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Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed -- whether it was lab results or patients’ notes. However, the road to this ...

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I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!” internally right before impact. I couldn’t believe what was happening as it happened.We should all be anonymous Samaritans
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Once upon a time, I was a lifeguard.  This was the natural result of swimming fairly well, Red Cross training, and team competition.  I saw myself as a handsome, tanned guardian at the ready.  OK, I was prone to self-delusion.  When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a ...

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The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to 
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We rely on the FDA to protect public health “by assuring the safety, efficacy, and security” of medical drugs and devices. The FDA takes its marching orders from Congress via the legislative process. One such law is the Compounding Quality Act of 2013, passed in response to a series of fatal infections due to improper compounding pharmacy processes. While such oversight is important and well meaning, the unintended consequences may be ...

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The first lecture in a radiation oncology residency program is “Radiation Oncology Emergencies,” to educate the new residents how to manage inpatient consultations and emergencies. While preparing my lecture this year, it occurred to me how useful this basic information would be to the physicians calling for the consultation. Sharing our thought process in triaging patient explains why we don’t rush to utilize radiation, even in cases of a cord ...

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I may not accept your insurance, but I will always accept you Just for the record: I am happy to see you -- irrespective of your insurance. I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason. I will not sign a contract with a health insurer that: Abuses and bullies me and/or my patients. Denies all my first claims. Reimburses me so little that I may go out of ...

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

  1. Smoking Worsens Psoriatic Arthritis. Patients with psoriatic arthritis who smoke have worse patient-reported disease features at baseline and don't respond as well as nonsmokers to anti-tumor necrosis factor (TNF) treatment.
  2. Heart Defects Still Often Found Late. Prenatal diagnosis of critical heart defects has increased, but more than one in ...

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She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year ...

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