Jet lag, also known as desynchronosis or flight fatigue, is defined as “extreme tiredness and other physical effects felt by a person after a long flight across several time zones.” Besides insomnia, symptoms of jet lag include weakness, fatigue, dehydration, body aches, diarrhea, dizziness, headache, irritability, and memory loss. Jet lag is one of the circadian rhythm disorders; others include shift work disorder, sleep phase disorder, and irregular sleep-wake rhythm. Symptoms ...

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Recently, I realized that patients coming to my office seeking vasectomies required an additional piece in their counseling. What led to this change? Earlier this month a study out of Harvard University suggested an association between vasectomy and lethal prostate cancer. Published in the Journal of Clinical Oncology, the researchers found that “men with a history of vasectomy had a 10% increased risk of prostate cancer, with a ...

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In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient's property and are used for a ...

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I performed my first paracentesis in November of my intern year.  It was 3 a.m., and I was on overnight call in a packed ICU.  The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name.  He didn’t know I was an intern.  He didn’t know I’d never even attempted a paracentesis before. After I finished, I added the patient’s name to my procedure card.  I hurried to get an ABG ...

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I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform. I’m not suggesting that an unwelcome ...

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It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has ...

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Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These  metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often ...

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Mr. D was my patient in the partial hospital program for the chronically and persistently mentally ill, and he was barely maintaining the level of functioning necessary to remain outside of the inpatient unit. A middle aged man with long-term psychotic and depressive symptoms, Mr. D’s care was made even more complicated by an extensive history of alcohol dependence and intravenous drug use that had left him with a severely ...

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November, 1999 was a watershed for physicians. It is then that the infamous "To Err is Human" report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact. To anyone who took the time to read the ...

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July as a newly minted intern: It was the best of times, it was the worst of times. The only analogy I can make is you feel like a middle school kid sitting in a PhD course, desperately trying to back-learn everything in a language of acronym alphabet soup you've never heard before. If medical school is drinking from a fire hose, this is trying to sip from Niagara Falls. You have ...

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Working the night shift as a resident physician You’ve changed. No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other. We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night.  Your persistence to move ...

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Top stories in health and medicine, August 1, 2014From MedPage Today:

  1. The 40-Minute Office Visit. The State stopped by to see us the other day. Wow, that sounds ominous.
  2. FDA to Expand Reach on Diagnostic Tests. The FDA plans to take over regulation of "home brew" diagnostic tests developed and used within individual clinical laboratories.
  3. Lytics for Stroke ...

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I’m a second-year medical student, and quite recently, a lecture left me with serious doubts about the state of social awareness in the medical field and schools. The dermatologist lecturing described a patient with secondary syphilis, stating he felt the case was odd since, “He [the patient] didn’t look gay or anything,” as if only homosexual men could contract that disease. I was hurt. I not only belong to a racial ...

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There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this ...

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I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is ...

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I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids!  Eczema? Steroids!  Psoriasis? ...

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There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive. As a result, medicine today is more about increasing patient ...

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Ask almost any physician why they chose medicine, and they'll answer, "I wanted to make a difference in the lives of patients." But in today's high-pressure healthcare environment, it's easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, "It's OK, as long as we're delivering great clinical care, we're delivering great care. After all, the massive heart attack was averted. The wound was stitched. What ...

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It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of ...

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Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land.  The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways. Our first response to this brave new ...

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