With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead. This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages. Response in the press has already raised issues with this, suggesting that this move would do little ...

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recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).”  Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices. First off, these parents don’t think we’re the enemy.  The reason they bring their kids to see us ...

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As a medical student looking to explore entrepreneurship, I quickly came across Shiv Gaglani’s October 2013 article in Entrepreneur, entitled “Why Medical Schools are Pumping Out Entrepreneurs,” in which he the highlights similarities and differences he sees between medical students and entrepreneurs. I was struck by his proposed differences -- he does not share his take on their origins, so I have come to delineate my own view. Medical students ...

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The smell of the grass, the crack of the bat and the roar of the crowd ... baseball season is back. As spring training gets into full swing, a new Major League baseball rule takes effect. Though contact will still be allowed at home plate, base runners will no longer be allowed to intentionally run into a catcher. The rule is intended to protect players from injuries, especially head injuries. Concussions ...

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During our weekly physician conference,  I discussed a patient with a suspected autoinflammatory disease.  An elderly male, he had a history of recurrent fevers, hives, and elevated inflammatory markers, which had gone untreated for many years.  Eventually, he developed renal amyloidosis, and was finally referred to rheumatology clinic for further evaluation.  Although he had many of the classic signs and symptoms of an autoinflammatory disease, his physicians had not recognized ...

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Imagine -- where would elective surgery be today if patients still worried about operating rooms exploding or developing liver and kidney failure from anesthesia? Having major surgery would be a very different experience without anesthesia.  Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers.  Dr. Bigelow's publication describing the safe administration of ether changed everything, and the New ...

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I hear providers groan when we talk about the patient experience and some even tell me that they have no impact on the patient experience, that’s an administration problem. Nothing is further from the truth. If you interact with patients, you influence the patient experience. Some providers think a full waiting room is a measure of patient satisfaction. Actually, it’s a measure of how long patients will tolerate a long waiting ...

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The CDC’s report on the overuse of antibiotics raises concerns that the infectious disease community has been aware of for decades. Unfortunately, systemic action to address these concerns is hindered by misperceptions about antibiotic therapy: that it is safe, inexpensive, easy to prescribe, and that early administration is the best approach. At first blush, antibiotic therapy appears to be safe. But there can be dangerous complications to its use. Clostridium difficile, an ...

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A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety.  He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts.  Indeed, ...

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Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital -- ever. (I am retiring from medicine in ten weeks.) I certainly wasn't there for the food, although the fare was much better than the daily servings in the doctors' lounge. Part of the night's agenda was a rousing talk by the hospital's new chief medical officer (CMO). A retired surgeon, the CMO ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin. Physical examination findings and vital signs are normal. BMI is 27. Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an ...

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When I meet a new patient, I’m frequently astounded by the health care he has received. I’ve met patients with absolutely no cardiac symptoms who have been receiving EKGs every six months for years. I’ve had patients brag to me about their annual executive physicals in which myriad tests including treadmill stress tests and chest x-rays were routinely performed. Patients get head-to-toe CT scans under the mistaken hope that they ...

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As an intern in the neonatal intensive-care unit (NICU), I am one of several doctors who rarely see or touch the tiny patients we treat. We sit in a back room off a distant hallway, far removed from the babies, reviewing lab results and blood gases on the computer. Much of the time I feel like the Wizard of Oz, controlling a marvelous machine from behind a curtain. The only uninterrupted ...

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As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come ...

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I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year.  She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty. Of note is that her symptoms seemed to start after a cruise.  I ...

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Bewildered, panicked, and disheartened. I watched my mother’s eyes dart back and forth as she read the pharmacy’s prescription cash price list, knowing she could not possibly dig deep enough in her faded purse to pay for her monthly medicines. In her early fifties, she did not qualify for Medicare, nor could we afford the COBRA payments that would extend coverage for our family since my father’s recent lay off. We ...

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I always pay attention to the reaction I receive from an audience at a talk or individual I encounter when I discuss the difference between a tool and a solution. Marketing a technology as a solution before it has been trialed, integrated into clinical workflow or even an EHR can even be met with legitimized skepticism by an educated purchaser. I offer a few thoughts on the subject which are critical ...

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From MedPage Today:

  1. More of the Bugs Kids Get Are Resistant. The rate of antibiotic-resistant Gram-negative bacterial infections in children is increasing in inpatient and outpatient settings.
  2. Salt, Obesity May Prematurely Age Young Cells. High sodium intake and obesity may act synergistically to accelerate cellular aging in adolescents, according to new research.
  3. Breast-Sparing Tops Mastectomy in New Analysis. Breast-conserving surgery led to ...

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While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC). During ...

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In my near-decade of practicing emergency medicine I have yet to receive a letter from a hospital congratulating me on how few CT scans I’ve ordered. Nor have I ever received a special award for diverting a potential admission to an outpatient referral instead. Rather, the push has always been the opposite. Fee-for-service models encourage the opposite behavior, and trying to do the most evidenced-based or cost-effective thing is not ...

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