Local hospital readmission data mirror national data in that twenty percent of hospitalized patients are readmitted within 12 days of discharge, and 30% within 30 days. Hospital reimbursement has changed to global, not fee for service payment. Hospitals and physicians need to create effective ways to prevent readmission. Readmissions also portend poorer outcomes. Therefore, it is our task as the physician community, to work collaboratively in this process. Currently, most patients ...

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Obstetric anesthesiologists not only relieve pain, they save livesA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As an obstetric anesthesiologist, it is my responsibility to make sure expectant mothers are comfortable during labor and delivery. It is important women understand their pain management options during childbirth by having discussions with their anesthesiologist and obstetrician. However, as an obstetric anesthesiologist, my role often extends ...

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"There are three kinds of men. The ones that learn by reading. The few who learn by observation.  The rest of them have to pee on the electric fence for themselves." - Will Rogers Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, eventually we should get it right. But we don't.  ...

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We’ve come to a sorry pass in American medicine when physicians are willing to spend a lot of money to attend conferences—not to learn how to become better physicians, but to find a way out of the pit of clinical practice. Few of us have the charisma (or chutzpah) to make a living in medical show business, like Sanjay Gupta or Mehmet Oz.  But apparently any physician today can be clever ...

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I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients).  The case on first glance didn't look very good for this defendant.  The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and ...

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An excerpt from Behind the Mask. Why do you do it? Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter ...

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How often does this occur?  A patient comes into the hospital with a chronic disease, or two or three.  The patient has worsening of their disease(s) because they have not taken their medicines.  They say that the medications are too expensive, but they have been smoking and/or drinking and/or using cocaine.  Usually they also have a DSM-IV diagnosis or two. You can fill in more information about the patient, unstable social ...

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New York City’s Mayor Bloomberg has proposed a ban on the selling of sugar-containing drinks in containers larger than 16 ounces in all types of eating establishments including street vendors, movie theaters, delicatessens and even stadiums. The purpose is to limit sugar intake and theoretically help people lose weight by saving them from themselves. The plan has received mixed reviews with some calling it a “nanny state” action. Also since a ...

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Going to the doctor can be confusing.  Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors.  While I think it's wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask.  There is nothing specific ...

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“I will never forget that day.” She smiled broadly. “It was about a week after my cancer surgery and I had finally worked up the courage to look in the mirror. I knew you had rearranged things a bit, okay. Moved stuff around. Taken things apart and jammed them all back together, right?” I probably would not have said it quite like that, but she was correct that her surgery had involved removing part of her ...

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