About a year ago, I was surprised to find out from my daughter that hookah pens were all the rage among the high school crowd. If you are, like I was, among the uninitiated, this is a device of roughly cigarette proportions that contains a battery, a tiny vaporizer, something to vaporize, and a button to make it go. Most commonly that “something” is propylene glycol and nicotine. Press a button and ...

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When I was an acting medicine intern in Manhattan's Bellevue Hospital at the turn of the century, all employees who provided the hospital's "ancillary services" went home between the hours of 5pm and 8am. It was the job of the on-call interns to fill in. If a patient needed a stat blood draw or IV line replacement in the middle of the night, his nurse paged the intern to do it. If ...

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As health reform sets in, hospitals are gearing up for many challenges. While some of these are new to the health industry, several are against the backdrop of old problems that have plagued us for decades. Speaking as a doctor who has worked in a number of different hospitals up and down the east coast, I would like to identify 5 of these that I believe are fairly universal. 1. Medication ...

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Rural medicine, I guess, can be defined as health care that happens in places that aren't big cities or referral centers. The vast majority of the populated earth's crust that has any health care at all is served by rural practitioners. I have done a little bit of rural medicine in Haiti, in Mexico and now a bit more in South Sudan. I have also worked in a rural health ...

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Who works at a hospital? (Again, just indulge me for now.) Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical ...

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I click open the x-ray viewer.  After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam.  Yet I audibly gasp as the chest x-ray loads.  The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes.  I begin to count the fractured ribs -- 1, ...

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Why must everything be so difficult? Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face.  The wheelchair appeared preposterously large for the aged figure cowering under the haggle of blankets.  They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out.  Her lips curled and she moaned deeply. Now Soni's mother had stopped talking ...

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One of the most satisfying sports is to make ourselves feel better by degrading another.  What better way to make up for our own inadequacy, then to shove someone else’s face in theirs?  We see this at work, in our families, in politics and in almost every type of social interaction.  Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is ...

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You may have missed this when it first appeared. Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of health care may be wrong. Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce health care spending. According to the report from the National Center ...

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I nearly died a month ago on a treadmill halfway through a stress test. The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours ...

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