Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as ...

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I have helped scores of women with frequent, recurring urinary tract infections (UTIs) over the years. First, involvement of your primary care provider is critical. "Must not miss" disorders need to be considered prior to going forward with the recommendations given below. Second, how do you define recurrent urinary tract infection? Most define recurrent UTI when a woman has 2 or more symptomatic urinary tract infections in 6 months or 3 or ...

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Stories can enhance health websites because they resonate with health information seekers, who find support and encouragement from the experiences of others like them. Two excellent examples are Weight Watchers’ Success Stories and Livestrong.org’s Survivorship Stories. Both sites include extensive libraries of well-written stories about people’s experiences losing weight and surviving cancer, respectively. Because of the effectiveness of stories in health websites like these, I challenge my Online Consumer Health students ...

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Recently, I had a discussion with a prominent academic family physician.  I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student. We had a wonderful discussion and agreed to disagree about merging primary care.   Long time readers know that I dislike the term for the tasks that outpatient internists do.  Most of the push for merger ...

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An eagle-eyed reader let me know that the Kaiser Family Foundation has a nice subsidy calculator up that you can play with.  You enter information about your income and situation, and you get to see how much health insurance and care will cost you in 2014. It’s not all good news. Let’s say you are a 60 year old divorcee in 2014.  You make $46,136, which is 401% of the ...

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The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record. It aired October 17, 1996. It was a turning point in American healthcare: ...

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Health reform will do a lot of things that most Americans don't realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do. One of the most recognizable components of health reform that didn't actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and ...

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Hard choices and healthcare reform are here.  Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama. Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA.  He is an outspoken advocate for the single-payer system, admires Britain’s National ...

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There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena. They are, respectively, from two stories that appeared on the same day in the Boston Globe: "Rate cap for insurer overturned" and "Officials give up cutting health perks."

1. An insurance ...

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It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians' hands. This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment -- surprise! It turns out that the ...

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