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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Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act.  Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack.   The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, ...

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Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: "Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks. Take your electrocardiogram on your smartphone and ...

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The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools. I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and ...

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