I'm no economist.  In fact I have never taken any business or accounting classes in my life.  But it doesn't take a formal education to get this.  We are speeding down the wrong path. The call at three in the morning woke me from a deep sleep.  I fumbled and strained to hear the whispered voice of the apologetic nurse.  Apparently Mrs. Thompson had scraped her arm against the wheel chair, ...

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I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost. Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping through all the prerequisite hoops before applying, it never occurred to me how inadequate my non-traditional ...

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7 steps to eliminating the war analogy in cancer careFrom a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. ...

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America is one of the sickest places on earth.  We have the best diabetic care, but the most diabetes.  First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease.  We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we waste most of the money from cigarette taxes on road repairs.  At every socioeconomic level, ...

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One of my biggest pet peeves is taking over the care of a floor full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers ...

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Recently, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging. First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients died during their hospitalizations, although it’s unknown how many of those deaths resulted from the infections, ...

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From MedPage Today:

  1. Sudden Cardiac Death Robs Many Years of Life. The burden of sudden cardiac death in terms of years of potential life lost is high compared with other leading causes of death in the U.S.
  2. HTN Guidance Takes Center Stage at NKF. Guidelines on hypertension management, particularly the JNC8 recommendations released last December, will be a major talking point at this year's ...

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Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell. My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, ...

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The relevance of physicians is dwindling rapidly I spend way too much time worrying about “silly” things, things I have no control over. I know this because my wife frequently catches me in the act and urges me to relax, to focus on what I can change. But despite her best efforts, I recently fell off the wagon again and became obsessed with a simple, seemingly innocuous question: Are physicians still ...

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The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of ...

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A Southerner at heart, I find myself in love with places.  We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits.  Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into ...

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Susan was 76 and dying at home in the days before hospice and before the use of the POLST form.  A neighbor came in the relieve Susan's daughter who went to the store.  Suddenly Susan stopped breathing and the neighbor called 911.  The medics came and, not having instructions to the contrary, did CPR and brought her to our ER unconscious and intubated.  The ER physician called me in the ...

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Physician suicide letters I asked why physicians were dying by suicide. Here’s what they told me: “I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” ...

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From MedPage Today:

  1. Survey Favors Medicare Pay Data Release. Almost three of out five readers believe Medicare's release last week of data on what it paid individual doctors was a good idea.
  2. Risk Score Predicts Arthritis Progression. A risk score encompassing clinical characteristics, serologic findings, and imaging tests could be used to predict which antibody-positive patients are likely to go on to develop rheumatoid ...

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Fifteen minutes. Give or take. That’s about how long a patient typically spends with a primary care doctor during an office visit. If you’re lucky enough to be healthy, maybe that visit comes once every year or two.  Or if you’re less healthy, maybe every few months. In either case, it’s not a lot of time. Not a lot of time to share all the relevant developments. Not a lot ...

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In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve.  Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but -- in general -- we still have a long way to go in our attitudes toward mental illness. I think it’s ...

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From an early age, I was encouraged by my family to consider a career in medicine. I was told it was a well-respected profession, offering financial security and community respect. Seeing the white coats, stethoscopes, and grateful patients at my childhood doctors’ visits made the field mysterious and intriguing, and these stuck with me as I grew older. I also developed a love for music at an early age; I ...

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News broke recently that Daniel Murphy, second baseman for the New York Mets, recently took two days off for paternity leave, causing him to miss Major League Baseball’s opening day and the season’s second game to be with his wife and child. Mike Francesa, a popular New York sports radio personality, devoted about 20 minutes of his Wednesday broadcast on WFAN to a rant against paternity leave. According to him, a ...

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Physician colleagues and their hospitals have been the targets of direct attacks during the past three years in Syria. According to UN war crimes investigators, Syrian forces have deliberately targeted hospitals, attacked field hospitals, and prevented patients from receiving medical care. A United Nations Commission of Inquiry independent panel published its findings to draw attention to what it called “an enduring and underreported trend” in the conflict. The report ...

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I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her ...

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