In June, a man became very ill during a flight into Lagos, Nigeria. On the plane, he developed vomiting and diarrhea, and he collapsed in the very busy airport. Contacts on the plane and on the ground had no idea that he had Ebola -- initially, he was treated for malaria -- and many health care workers and bystanders on the plane and in the airport were exposed to his ...

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Years later, I now wonder if I overstepped my boundaries. Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a ...

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Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers. Ebola is a nasty virus, surely, with a case fatality rate of 80 percent. Overall health and nutrition as well as living ...

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The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic. We don’t decide to make a patient observation ...

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Top stories in health and medicine, October 31, 2014From MedPage Today:

  1. Minor Memory Problems Merit Attention. Patients who reported having lost a step mentally were at nearly triple the risk of being diagnosed with definite cognitive impairment later on, albeit with a lag of about 6 to 10 years.
  2. Munchausen by Proxy: A Case Study of Abuse. If you do ...

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The problem with wedding planning when youre a surgeonThe other day, I got into an argument with my parents about choosing wedding décor -- and I blame it on my surgical training.  My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of ...

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Just yesterday I was searching for a local surgeon, and on one website he had 2 out of 5 stars.  Hardly anyone was recommending him.  Yet prominently featured on another site he had 4.7 out of 5 stars.  Both sites had a good number of reviews.  What’s going on?  Is one site cherry picking the reviews?  Is someone falsifying reviews on one of the sites?  Which reviews can I trust? ...

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The present time has one advantage over every other - it is our own. - Charles Caleb Colton The cherubic young man smiles from the black-and-white class photo. His open, relaxed appearance captures my attention. He sits on a wooden bench at the far right end of the front row, his sharp white shirt and patterned tie cinched tightly beneath his three-piece wool suit with the stylishly wide lapels. He looks directly at the camera ...

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“I’m here to say ‘Yes, they can,’ which is different from ‘Yes, they always do,’” says James Moore, MD, president-elect of the California Society of Anesthesiologists (CSA). To the contrary, enthusiasm for electronic medical records (EHRs) is part of a “syndrome of inappropriate overconfidence in computing,” argues Christine Doyle, MD, the CSA’s Speaker of the House. The two physician anesthesiologists (and self-identified “computer geeks”) squared off in a point-counterpoint debate in New ...

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Why company paid egg freezing threatens medicine and motherhood Recently, reports surfaced that two Silicon-valley giants, Apple and Facebook, are covering elective ooycte cryopreservation, a.k.a. egg freezing, for its female employees.  Silicon Valley, like medicine, has a shortage of women at the top and it is presumed that this move will attract more women to enter -- and stay -- in the field of technology. As both a recent graduate of medical ...

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Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error. That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health ...

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Top stories in health and medicine, October 30, 2014From MedPage Today:

  1. Disease Activity Linked to Lipid Elevation in RA. Measures of disease activity at baseline and changes in those markers with tocilizumab (Actemra) treatment among patients with rheumatoid arthritis (RA) were independently associated with increased risk for major adverse cardiovascular events.
  2. Ebola: Vinson Thanks God and the Medics. Nurse Amber ...

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A few weeks ago an emergency room doctor called our infectious disease physician group concerning a patient who had returned from Liberia and was having nausea and vomiting. Several of the patient’s family members had died of Ebola. As panic struck us, our decisive question was: When did he return from Liberia? The Centers for Disease Control and Prevention guidelines for screening and isolating patients for possible Ebola infection are clear: ...

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Instead of being hysterical about Ebola, respect it Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested. I was reading a story about a German tourist (it’s usually a German) who was attacked by ...

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Physician key opinion leaders (KOLs) have been viewed as a valuable resource in the pharmaceutical (heretofore referred to as pharma but included are medical device companies) industry. In one study in which 100 KOLs were surveyed, the most important characteristics of a KOL were, “regularly sought out by their colleagues for opinions or advice, speak often at regional or national conferences have published articles in a major journal during the past ...

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There will never be any compromise acceptable to the die hard defenders of psychiatry or to its most fanatic critics. Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem. Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental health treatment, not its necessity or any of its benefits. I have spent a good deal ...

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Patient satisfaction: Should that be the real mission of health care? As the patient satisfaction movement races full steam ahead, the time is perfect to regroup and define what this whole thing is really all about. Anyone involved in health care, and particularly hospital care, knows that the term “patient satisfaction” has become a buzz phrase recently. Sadly too it’s also evolved into a bit of a bumper sticker in hospital administration circles ...

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After reading a book about conducting good business, you’ll likely review the concept of adequately meeting demands for clients or consumers. Whether a company is thriving due to lower pricing or higher quality, in the world of business, the golden rule is provide value or go bankrupt.

One industry has seemingly remained immune from this concept, however. In the past few decades, especially, health care has unequivocally failed in ...

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Top stories in health and medicine, October 29, 2014From MedPage Today:

  1. Add-on Tx Less Likely in T2D Patients on Metformin. Patients with type 2 diabetes who don't start out on metformin may be at higher risk for needing additional therapy.
  2. Lung Donation After Cardiac Death Shows Promise. Lung transplantation after cardiac death achieved key endpoints comparable to those attained with ...

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Health reform: Great for patients, but this doctor lost his job As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic ...

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