Years later, I now wonder if I overstepped my boundaries. Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a ...

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Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers. Ebola is a nasty virus, surely, with a case fatality rate of 80 percent. Overall health and nutrition as well as living ...

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The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic. We don’t decide to make a patient observation ...

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The problem with wedding planning when youre a surgeonThe other day, I got into an argument with my parents about choosing wedding décor -- and I blame it on my surgical training.  My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of ...

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Why company paid egg freezing threatens medicine and motherhood Recently, reports surfaced that two Silicon-valley giants, Apple and Facebook, are covering elective ooycte cryopreservation, a.k.a. egg freezing, for its female employees.  Silicon Valley, like medicine, has a shortage of women at the top and it is presumed that this move will attract more women to enter -- and stay -- in the field of technology. As both a recent graduate of medical ...

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Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error. That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health ...

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There will never be any compromise acceptable to the die hard defenders of psychiatry or to its most fanatic critics. Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem. Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental health treatment, not its necessity or any of its benefits. I have spent a good deal ...

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Patient satisfaction: Should that be the real mission of health care? As the patient satisfaction movement races full steam ahead, the time is perfect to regroup and define what this whole thing is really all about. Anyone involved in health care, and particularly hospital care, knows that the term “patient satisfaction” has become a buzz phrase recently. Sadly too it’s also evolved into a bit of a bumper sticker in hospital administration circles ...

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After reading a book about conducting good business, you’ll likely review the concept of adequately meeting demands for clients or consumers. Whether a company is thriving due to lower pricing or higher quality, in the world of business, the golden rule is provide value or go bankrupt.

One industry has seemingly remained immune from this concept, however. In the past few decades, especially, health care has unequivocally failed in ...

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There are times when a common cliché may be the best way to describe academic medicine in today’s medical centers.  In fact, I have heard patients and their families complain about this, way too often.  Simply put, there are many occasions when it seems that there are too many cooks in the kitchen. When someone gets admitted to the hospital, chronic problems and acute complaints are identified and addressed through a ...

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