"What's the most important finding on this chest x-ray?" There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen. "Um, the pleural effusion?" whimpered a third-year resident. "No!" barked the attending. The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently. "Come on, folks!  Look!" And try as they may, no one saw it. "The name, folks, ...

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It had all been so easy when Jim was still around.  Lisa's ex-husband had many shortcomings, but being a critical care specialist sure came in handy.  Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information.  But then Lisa's father died, and the emotional and physical stress brought the unstable union ...

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Since an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a "say what?" dangling from your lip, we are on the same page. Let's populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as "prevention" really makes sense. Prevention ...

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New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators. The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients ...

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The story of the surrogate offered $10,000 to have an abortion by the couple who were paying her to carry their pregnancy has been making the rounds. If you don’t know the details, let me catch you up

  • Woman hired to be a surrogate for the fee of $22,000
  • Couple who are paying have 3 children, but had a lot of pregnancy complications. Two children spend months in the hospital ...

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When the American College of Emergency Physicians (ACEP) decided not to join the Choosing Wisely campaign, I was among those who expressed disappointment with this decision, in part because I have long been a proponent of efforts to encourage more cost-effective care in the ED.   In fact I had already independently done a significant amount of work in the Read more...

This question was what drove me to graduate school for an MPH degree a few years ago.  I was finishing up my family medicine residency at, arguably, one of the top residency programs in the nation.  I had been well trained in both medical science and doctor-patient relationship skills.  Yet my patients still consistently did not adhere to my advice. I was not disappointed in my MPH studies.  It turns out ...

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Having married parents is good for children. That's why the American Academy of Pediatrics (AAP) thinks that same-sex couples should be able to marry. In a policy statement, that's exactly what they said. It's going to put the AAP in the middle of controversy--but it was the right thing to do for children. There are currently almost 2 million children being raised by gay and lesbian parents in the United ...

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What does the 21st century physician look like? I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.” Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow. (As for the 21st century in general, given the speed at ...

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Next in a continuing series. Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there's something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving ...

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