I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a Fried Green Tomato BLT, and Shrimp and Grits for breakfast, has my vote! To the point: my question to these esteemed emergency medicine educators was this: "Do you ever have irrational fears about the people you love, because of what you do?" The answer was a resounding "absolutely!" Like me, ...

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The ACA passed and is already in trouble. The Republicans are up in arms, calling the ACA an overreach of a totalitarian governmental regime. The Democrats are defending it, promoting its cost-saving measures as a progressive step forward for America. To say the rhetoric has heated would be an understatement. I’m not here to debate politics though. In the run up to the Supreme Court’s ruling on the ACA and the ...

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Too often, bedbugs prevent cost-effective and quality health care – both literally and figuratively. In the literal sense, consider the case of an elderly woman we’ll call Mary. A frequent visitor to emergency rooms in Northern Colorado, Mary has a long list of medical and behavioral health problems. Recently, a pilot project implemented by the North Colorado Health Alliance brings together a team of providers representing different walks of the health care ...

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Choosing Wisely is the new campaign advocated by the ABIM Foundation to help physicians "be better stewards of finite health care resources." The recommendations in the campaign have been published in Consumer Reports and has been distributed to AARP members. At first glance, the campaign seems to make sense. Limit unnecessary testing and decrease costs. However, I predict that the Choosing Wisely campaign will also have many less desirable effects. I picked ...

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The New York Times recently published an article titled “A Life-Death Predictor Adds to a Cancer’s Strain” or, alternatively, “Genetic Test Changes Game in Cancer Prognosis.”  The piece is interesting on several levels, but, to me, serves to highlight an increasingly common ethical conundrum: are physicians obligated to seek knowledge that is available but has no possible medical benefit? Most of us are familiar with the Schrödinger's cat thought experiment ...

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Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing). However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that ...

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You know the headlines. You read them and hear them and see them every day. Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage. A family including mother and young children in a van are ...

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Most of us do not want to die in the ICU tethered to tubes -- not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep -- most have a slow sometimes excruciating decline to death. As we ...

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Chico (all identifying information removed) was a patient we cared for in the hospital. Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis. From my point of view–an instructor teaching residents and medical students–there were two key questions about Chico: 1. What caused his kidneys to fail? 2. Given his kidney failure was “acute,” was there any chance that it’d be reversible? Could Chico’s kidneys heal to the point where ...

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LeBron James exploded past his defender and raced towards the lane.  Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air.  LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman. Offensive foul? Maybe if it had been the first quarter.  But given that this was the last minutes of a tightly fought game, the referees ...

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