The business value of medication adherence tools is coming into focus.  For years, I remarked that, while we could create a case for why adherence was the right thing to do, we had great difficulty creating the right financial incentives to move these programs from curiosity to scale.  That is changing now with the collision in the marketplace of new payment models and exorbitantly priced pharmaceutical products. The poster child for ...

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Do you know what the operator or person at the front desk is saying about palliative care?  When people call, saying the want palliative care, how are they responding? A study being presented in abstract form at the palliative care and oncology research symposium addresses this simple but critical question. Researchers at Duke (Kathryn Hutchins, third-year medical student first author, Arif Kamal, oncopal researcher, senior author) cold called 40 major comprehensive cancer ...

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It is one of the most boring truisms on the planet: “Practice makes perfect.” It is also one of the most misleading. Practice merely ingrains certain patterns after deciding on the best course of action after constant criticism and problem-solving. Performance requires that the body forget the work required to ingrain the pattern and let the pattern happen. Performance requires that we drop all criticism and technical considerations. These two ...

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“You must respect the body you are trying to heal.” I heard this said twice into my headphones, the second time more slowly and firmly than the first, while I sat on the runway about to take off. It continued to echo in my head over the course of the flight. As a physician, the reference to healing a body has obvious resonance. However, as I embarked on yet another gathering ...

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As the process of applying to medical school and residency becomes hyper-competitive, we medical students often feel forced to pursue our passions only in ways that are “high yield.” It may seem counterintuitive, but the further we go in our medical training, the more inertia we seem to have about giving our time and energy to the everyday people in need. We’re so pressed for time from our participation in ...

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Fall brings school buses, a freshening breeze and an avalanche of meetings.  There are seasonal sales, myriad projects and the splendor of colored leaves.  The season is also announced, again and again, by a particular peculiar and perilous decision, which, no matter how much I try, I do not fully understand. Frankly, I just don’t get it.

“Jane, it is time to start chemotherapy.” “What are the side effects?” “Well, this is powerful ...

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Dear health care technologist or regulator, The world of health care is changing exponentially. Speaking as one the nation’s over 800,000 physicians, I can confidently say that most of us understand the fact that the current health care system is unsustainable, and can’t carry on as is. There are many potential solutions to explore, and everyone in health care needs to try to come together in an attempt to address these ...

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Someone told me that the reason certain others don’t respect my advocacy on behalf of physicians more is simply that I am a woman. I am seeing this the more I speak up on issues facing doctors these days. It is now the 21st century, and there are a large number of women practicing medicine. In fact, the number of men and women entering medical school these days is nearly ...

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One cold February morning during my third year of medical school, I walked through the entrance of the rural hospital where I was doing a nine-month rotation and made my way to the nurses' station. Feeling the warmth return to my face, I set down my coat and bag and hung my stethoscope around my neck. The charge nurse, Barb, waved me to her computer. "Kristie, you have a patient." She shuffled through ...

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Her 17-year-old legs dangled over the edge of the exam table. She had come for a prescription of oral contraceptives. Her boyfriend, she said, had been patient. He wasn’t ready to be a father, and so they were waiting. But lately he had started to put the pressure on and asked her to come in. She wasn’t eager for this change in their relationship, but it seemed like the next ...

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You won’t find me at any haunted houses this weekend. I don’t need any costumed creeps jumping out at me when I least (or most) expect it. I’ve never been a huge fan of strobe lights, fog machines, bad makeup, or canned Vincent Price laughter. My day job is scary enough. Some like to say that anesthesia is 99 percent boredom and 1 percent terror. They’re half right. The 99 percent is rarely boring. ...

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If you attended medical school, you learned in week one that American health care started becoming scientific in 1910, with the publication of the Flexner Report. Before then, only some medical schools were authentic while many others were anything from carnival booths to outright frauds. Abraham Flexner, a respected educator, had been hired by industrial barons John D. Rockefeller and Andrew Carnegie, who were determined to bring health care out of ...

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Sometimes an interesting thing happens on patient rounds. Rounds are a traditional exercise in hospitals going back at least a century. In the old days, this meant the physician going from patient to patient. He (it was nearly always he back then) went over the patient’s progress with the bedside nurse, examined the patient, reviewed pertinent test results, made an assessment, decided on a plan for the day, and gave ...

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img_1365 When I graduated from medical school, my dad gave me several hundred dollars with instructions to buy something special. It was a kind gesture, but the pressure to self-select a meaningful gift was almost too much. I wanted something to commemorate my transition from student to doctor. Books, stethoscopes, and the like seemed so uninventive. I wanted something for residency that would be ...

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I read another post about the poison of GMO, corn syrup, baby formula.  One more post in an extensive newsfeed.  It is opinion, and I can scroll past, but it feels like another not so subtle reminder of the “breast is best” undercurrent that permeates everything baby related. As a physician, I feel that breastfeeding is ideal.  When I was a third-year resident, and I had my first baby, I was ...

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When I was a little, I used to love puzzles. You could find me with pen in hand, sprawled out on my bedroom floor, nose buried deep in word searches or my Highlights magazine. I wanted to know how things worked. I loved building block sets and making up games with my older brother during summer vacations. Over the years, that curiosity eventually morphed into my current profession as a ...

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Prior to her death, a courageous young woman named Jess Jacobs, who suffered from POTS (postural orthostatic tachycardia syndrome), wrote about the worst health care experience of her life.  It is a somewhat horrifying account of hospitalization in Washington D.C.  Her goal was to work toward meaningful health care changes in the system for the better. When I came across the story of another young woman afflicted with this ...

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My physical therapy education occurred within Harvard Medical School. My college, Simmons College, worked with Harvard in those days to prepare us (13 women) to enter the field with knowledge and respect for the roles and rules of clinical medicine. In 1966, I was taught to stand up when a physician entered the room, to hand over the chart and open the door. There was never any doubt who was who. ...

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If your partner is a doctor or medical student, prepare yourself for dozens -- possibly hundreds -- of conversations about their career. If you’re lucky, these conversations are pleasant moments in which you get to show pride about your partner’s accomplishments, discuss the challenges openly, or talk about something you have learned as an outsider looking into the medical establishment. Unfortunately, many of us experience a far more frustrating reality when ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated for a diagnosis of acute kidney injury. He was diagnosed with gastroesophageal reflux disease 3 weeks ago and was prescribed omeprazole. Several days ago he noticed lower extremity swelling and decreased frequency of urination. Laboratory evaluation showed a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). ...

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