A few months ago, the father of a primary care physician came into the emergency department with syncope.   He was 102 years old.  His age was more than double his heart rate.  That may or may not be bad but it certainly is often a reason for more testing.  The senior resident seeing the patient ordered an EKG, a battery of labs, a head scan,  and anticipated admitting the patient ...

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When I first met Ralph, he was 82-years-old.  He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer.  Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery.  Ralph made it; his wife died.  Today, twelve years later, he brings me treasures from his metal detecting hobby on the ...

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shutterstock_129893702 I read an article in the Boston Globe about how doctors are flocking to get Master of Business Administration (MBA) degrees in record numbers. The prestigious program at the Massachusetts Institute of Technology, MIT, apparently now has more students from the health care sector than any other field -- accounting for almost 20 percent of the class. A large number of these ...

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shutterstock_78905827 I have a shiny new Bluetooth device.  So now, as I zip around town, I can speak without my hands touching my phone. It’s relevant because our county is passing a ban on cell phone use, unless it is hands-free. This is a national trend, of course, and the catch phrase is "distracted driving." Everyone knows that distracted driving is bad. ...

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In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list.  Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions. This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In ...

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shutterstock_193958318 It's time for the American physician to stand up. We will no longer bend to the tyranny of bureaucracy, the venom of litigation or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs ...

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After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA.  Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true.  The place is a mess. Let’s start with the computer system.  The VA medical record system has been held up as an example of an effective EMR system, in which ...

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Carrie is a 72-year-old retired real estate agent with a high school education. She raised three kids, but they do not talk to her anymore.  Since her husband died, Carrie has lived alone.  A melanoma was removed from her right shoulder 2 years ago.  In my office, we stare at the CT scan display of a mass in her right lung. “What does that mean?” “Well, we wouldn’t know for sure until ...

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The prevailing sentiment in pop-culture nutrition -- propagated in books, blogs, and blather; documentaries and diatribes -- is that everything we thought we knew about diet and health until yesterday is wrong. Actually, we have a much bigger problem than that. To one degree or another, everything we thought we knew about nutrition is right -- and we are obligated to do something about it, or stay fat and sick. That's ...

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Recently in one of the Johns Hopkins Hospital's intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s family -- two daughters and a husband -- suffered at her bedside, Mandy saw their need for comfort, and she responded. Although she was busy with nursing tasks, she delved ...

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