So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing. In this country, we traditionally eat three meals each day.  Why not four or two? We prefer soft drinks to be served iced cold.  I’ve never tried a steaming hot Coke.  Maybe this would be a ...

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Dont be stupid, and other wise words to new college students Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me me give you some wisdom. First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for ...

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My brother and I, both optometrists, had a heart-to-heart discussion about the loss of one of our patients. We discovered he was not taking his medications as prescribed, which was leading to vision loss. When pressed, the patient said he had a choice of eating, supporting his family, or purchasing his medication. He was under the impression that the $150 price for his generic Lipitor was “about the same” at any ...

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I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless: “Modern medicine had to start somewhere.” On the third episode, last Friday ...

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Top stories in health and medicine, September 2, 2014From MedPage Today:

  1. Reflections on Effect of Stand Up To Cancer. The week before Stand Up To Cancer's (SU2C) fourth-biennial live 1-hour commercial-free prime time roadblock telecast on Sept. 5, Nobel Laureate Phillip A. Sharp, PhD, shared his views about the efficacy of this mass media approach to educating the public about cancer and ...

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The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the ...

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What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

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The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it. Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, ...

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Dissent and cynicism: Learning from listening to doctorsDissent and cynicism: Learning from listening to doctors An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care I just listened. They were very unhappy and angry. I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that ...

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What every college freshmen ought to know about sexual assault Dear college freshman, I just saw you in clinic a few weeks ago; your last check up before college. We talked about a lot of stuff, updated shots, filled out forms, hugged good-bye; crammed in what we could in just a few minutes. It was a great to see you. Now that you are out of the office, away from the distractions of a buzzing ...

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MedPage Today recently tackled a very controversial issue in medical practice.  The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures.  As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice. According to the 
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Top stories in health and medicine, September 1, 2014From MedPage Today:

  1. ZMapp Ebola Drug Effective in Macaques. A controversial cocktail of Ebola antibodies was safe and highly effective in saving the lives of rhesus macaques, even as the animals neared death from the virus.
  2. Depression in Cancer Common But Untreated. The vast majority of clinically depressed cancer patients receive no ...

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My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

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Part of a series. Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.”  Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it's every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will ...

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Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly ...

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Having been born and raised in the United States, I have become accustomed to the reputation of the U.S. as being ahead of the curve in terms of advances in numerous fields including medicine, and the research that we produce in these fields strongly backs up this claim. I have been reminded of this over the past few days while following coverage of the Ebola outbreak in West Africa. American health ...

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Many organizations cook up recommendations for the number of fruit and vegetable servings you should eat every day.  Well known examples include the USDA which suggests two cups of fruit and two and a half cups of vegetables daily (approximately 8 to 10 servings), the American Heart Association which recommends 8 to 10 and the Harvard School of Public Health suggests somewhere between five and 13 servings of fruit and ...

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The Health Information Technology for Economic and Clinical Health Act of 2009 committed to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care while promising dramatic improvements in quality, efficiency and safety.  Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment. First, EHRs were designed to document the provision of health care ...

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