Slightly over a year ago, the Department of Justice (DOJ) launched an investigation of a large number of institutions regarding concerns that implantable cardiac defibrillator (ICD) procedures were performed for reasons outside of the criteria set forth in Medicare’s National Coverage Decision (NCD). This investigation occurred just after Al-Khatib and others published a report January 4, 2011 in JAMA that suggested as many as 22.5% of implantable defibrillators implanted ...

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Christopher Hitchens, noted author and philosopher died December 15, 2011 leaving behind many essays, books, and other writings as well as contributing to several lectures, ethics/religion debates, and TV talk shows.  His acerbic style often ruffled feathers as he attacked religious dogmatism. As one of the most famous outspoken atheists of this era, his thoughts on being diagnosed with an incurable disease would be a powerful insight into how atheists might approach ...

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Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor ...

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An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by a former chairperson of the much maligned Institute of Medicine, is that primary care doctors are over-using cancer screening tests because they do not understand the statistical ramifications and conclusions ...

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One fine fall morning last year my wife turned to me and said: "I want a tummy tuck. There are no rules against you doing that for me are there?" We had talked about tummy tuck surgery for her several times over the years. She had had a gastric bypass a decade before we had met and was a pretty good candidate. No cigarettes. Well she did have a few surgical ...

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Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer. Appropriately timed end-of-life discussions are the supposed answer, but for doctors they are emotionally draining, interpersonally complex, and ...

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"It is getting worse everyday." "Medicare fix at the last moment." "Too much paperwork not enough time with patients." "ACO’s and bundling." The headlines scream at us everyday. If we have one word that underlies the medical community it is fear. The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching ...

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Where is the physician outrage? Right. Here. I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics. I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins. I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as "rape." If I insert any ...

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As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much. Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, ...

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Recently there was a lovely story in the New York Times about a young couple struggling to navigate the complexities of a romantic relationship.   Both in their early 20’s, dating is a relatively new experience for them.  She likes physical affection; he prefers sitting alone on the couch.  She wants a pet; he is allergic.  They are learning to negotiate the small things while clinging to their common affection for ...

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