What does a good death mean to you? In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor. At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. ...

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The publics lack of trust in science is alarming Cynicism appears to have replaced idealism as America’s defining characteristic.  So many of us just don’t trust the government, scientists, the clergy, journalists, business CEOs, labor unions, lawyers, or just about anyone for that matter, to say or do the right thing. Two years ago, the National Journal reported that as a consequence of the Great Recession, “Americans are losing faith in ...

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Top stories in health and medicine, November 19, 2014From MedPage Today:

  1. IMPROVE-IT Results Turn Up Volume on Guideline Debate. The long-awaited results of the IMPROVE-IT study comparing Vytorin (ezetimibe/simvastatin) to simvastatin in high-risk patients revealed a small but significant benefit, and a large -- and possibly equally significant -- rift regarding the cardiovascular prevention guidelines.
  2. State Exchange Situations Vary at ...

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I've waited to address this sensitive topic until after the midterm elections, when political slogans such as the phony "war on women" and trumped-up threats to religious liberty were discarded like so many campaign posters. It was curious to see the American Congress of Obstetricians and Gynecologists (ACOG) and Planned Parenthood attacking Republican Senate candidates for supporting over-the-counter birth control pills without a prescription -- a position that, if the pills ...

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I didn't think much of it at the time. Most physicians can trace back and recall their first patient.  For some, it is a clinical encounter the third or fourth year of medical school.  The more creative may point to their cadaver during first year anatomy and nod knowingly.  My first patient was a mouse.   Or shall I say a group of them? My freshman year of college, I volunteered in ...

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A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours. Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay. The study, published online in the ...

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Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers.  The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt.  The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.” The protests are ...

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What chaos theory has to do with family medicine Open a new browser tab and check your favorite weather forecast website or app. Right now. How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not? Have you ever wondered why they can’t ...

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Primary care fits some medical students. Heres one. One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual -- and to many of his colleagues -- inexplicable decision.  Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.”  Many view his choice of primary ...

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Top stories in health and medicine, November 18, 2014From MedPage Today:

  1. Weight Loss Relieves Symptoms in Knee OA. Obese patients with knee osteoarthritis (OA) who maintain an initial weight loss report fewer symptoms compared with their baseline level of symptoms.
  2. Age and Sex May Distort Biomarkers in Early RA. Age and sex are independently associated with levels of erythrocyte sedimentation ...

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The religion of emergency medicine: Its time for a reformation Emergency medicine, like every specialty, is its own religion. And on many levels, it tracks right along with the progression of religions from their ancient origins to their modern incarnations. Our unique profession grew out of a pressing need for physicians who could provide immediate and life-saving care to the sick and injured, at all hours of the day or night. The ...

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According to the American Medical Association, there were approximately 685,000 physicians in patient care, post-residency, not employed by the federal government, in 2012. 60 percent of these physicians practiced in independent private practice, and 84 percent were working in small to medium size practices. Assuming that the trend to employment of doctors by health systems continued unabated to this day, over half of practicing physicians are still in private ...

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Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any ...

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Remember when we were trying not to panic about Ebola? Seems like that was only yesterday. Oh wait -- it was only yesterday. But it already seems as if we are trying to remember that we were trying not to panic. I listened to my favorite news radio station out of New York City while driving to the office recently. They address all of the major news stories in the first eight ...

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Information technology clearly has a long way to go before it delivers on the immense promise of technology to truly improve health care. Most of the current solutions -- quickly rolled out in response to meaningful use requirements -- are slow, inefficient and cumbersome. Physicians (and nurses) spend far too much time staring at their screen and navigating the system, often to the detriment of patient care time. A study published last ...

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Walk in the shoes of a cancer patient We sit, we listen, we attempt to focus and absorb what we are required to know. We learn how to give bad news, even using one another as makeshift “standardized” patients. How does one “standardize” a patient anyway? Who knows, who cares, time to cram for the endocrine exam. But what happens when you stop pretending? When you wake up one morning ...

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Top stories in health and medicine, November 17, 2014From MedPage Today:

  1. Ebola: Signs of Progress, CDC says. The response to the Ebola outbreak in Liberia is showing encouraging signs of progress, with downward trends in new cases especially in two regions of the country that had been hot spots.
  2. Millions Of Medicaid Kids Missing Regular Checkups. Millions of low-income children ...

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Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not ...

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It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket. They call these messages "system notices." OK, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic ...

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Patients are doubly screwed by the malpractice system Part 3 of a series.  Read part 1 and part 2. The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. "Ho hum," says a lawyer who read my first two posts in this series. "Get out the violins." It's as if, because I make my living operating on ...

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