What is value in cancer care? It depends. Value. A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern. At the crux ...

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Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work history (if any). Copies of key documents -- medical degrees, ...

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I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long term care first from providers I ...

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Establishing a digital presence is rapidly becoming a necessity for health care professionals, medical practices, and institutions. Yet something that often gets obscured in the discussion is the fact that at its heart, digital media is about people. As such, it’s about relationships, and it’s about communication, and increasingly, your digital footprint means educating, engaging, and growing your audience. When you do this in a way that authentically reflects you and your ...

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I stared down at the tired, deteriorating woman sprawled across a bariatric bed before me. A breathing tube was in her throat while multiple catheters pierced her arms and neck, pouring powerful medications directly into her veins. Among several functions, these infusions would maintain her blood pressure high enough to keep her organs alive. This was my initial, visual impression of a patient I was responsible for during my first ...

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This year's flu vaccine, as you likely know, is taking a drubbing. The contention is that CDC flubbed, and didn't get quite the right flu strains in the mix. That is apparently true, although more the "fault" of the influenza virus and its natively wily ways, than of the CDC. Either way, the drubbing is disproportionate to any flubbing. The drubbing occurs in the context of a strong, new ...

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Top stories in health and medicine, December 19, 2014From MedPage Today:

  1. High-Dose Flu Vaccine Better for Frail Elderly. For frail older people living in long-term care, a high-dose inactivated influenza vaccine is a better option than the standard drug.
  2. Look into SGLT2 Fracture Risk, Researchers Urge. Look deeper into the potential relationship between SGLT2 inhibitors and bone fractures.

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We all have prejudices. We have racial prejudices. Religious prejudices. Gender prejudices. Occupational prejudices. Age prejudices. Weight prejudices. Height prejudices. We prejudge based on hair style. Language. Accent. Clothing. Shoes. Attractiveness. Tattoos. Names. Jewelry. Family. Hobbies. Cars. Schools. Type of home. Music. Where a person lives. What type of work a person does. What a person reads. Talents. Disabilities. Physique. Medical history. Injuries. Opinions or assessments by others. No one is ...

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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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Dont quit medicine. Here are 5 reasons why. 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 ...

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Dont dread internship: 5 truths from a first year intern 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 ...

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Suicide: A doctor’s story 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 ...

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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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