From MedPage Today:

  1. Is Belphen the Next Blockbuster Diet Drug? Even though there are scant data, obesity researchers and patients have already put a name to a potential new weight-loss craze: Belphen, a combination of lorcaserin (Belviq) and phentermine.
  2. Does COPD Dull the Mind? Mild cognitive impairment was more likely in patients with chronic obstructive pulmonary disease (COPD), particularly the longer it went on.

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You have to earn your cynicism.  That’s my rule.  Young pre-med and medical students, even some residents don’t have the same right to cyncism as the rest of us who have labored in emergency departments for years, for decades.  The same goes for nurses fresh on the job from training, and ward secretaries who so recently were high school kids. It always troubles me when these people start working in our ...

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His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school -- and threw on an MBA for good ...

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Do you believe that I have to mention this?  I can’t believe it either but since the advent of the EMR, this seems to be an issue; a really big issue.  Amazingly enough, you are there, as a doctor, to treat the patient and not the computer.  You would think it was the other way around with all the bogus quality indicators, meaningful use baloney and pay-for-performance nonsense being stuffed ...

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This month, the literature and medicine group at my hospital met to discuss Arthur Miller's Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with "a shoeshine and a ...

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Frontline caregivers across the United States -- and in many other countries, no doubt -- are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating in all of these efforts risk overwhelming health care professionals, who ...

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I was a work today and I was given this message, “ —–'s husband called and wants you to call back right away!  He sounded very upset.  His wife died.” Uh oh, I thought to myself, this is never good.  It was a patient I remembered well, that I had seen repeatedly for a chronic problem, and who always came with her husband.  We seemed to get along well.  I didn’t ...

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Most people, regardless of their political leaning, can agree that the market for health care in the United States isn’t really working well. Take one step further, though, and disagreement rapidly ensues. On the left, the common understanding is that a market failure has occurred, and that the proper thing to do is have government intervene to correct that failure -- usually by expanding public insurance programs, subsidizing private insurance, and ...

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From MedPage Today:

  1. Vitamin D's Role in Weight Loss. Simply supplementing vitamin D as part of a dietary intervention won't necessarily aid weight loss, unless patients actually achieve levels of 25 (OH)D of 32 ng/mL or more.
  2. Less Invasive Surgery Gets Hip Patients Behind Wheel Faster. Patients who undergo hip joint replacement surgery using minimally invasive techniques can safely return to driving 2 weeks ...

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“It’s a disgrace to the human race.” The talented, high school senior physically cringed as she described the app, adding, “it’s just horrifying what people put on there.” Teens in my office have nearly universally agreed in the repulsive nature of one of the newest social networking apps called Yik Yak. The app is causing disruption within our local community; being described as a way to cyberbully, offend, and generally disgust anyone anonymously. App users, or ...

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Should doctors grab a .health domain?So, you're setting up a website for your practice. You thought you'd just grab a .com, .net, or maybe .info. But now there's .health. Will one of those set you apart from the .com crowd? So what do you need to know about these new domains? 1. Will patients come looking for me on .health? The bottom line is that it's highly unlikely patients ...

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"Old school" is difficult, but doable for teaching attendings.  While prioritization is the key, having a basic framework will help. Here are my personal keys: 1. Sit at the bedside and retake the history of present illness on those patients in whom taking the history is clearly a key.  For example, someone admitted with presumed community acquired pneumonia should have a short history including fever and perhaps night sweats and possible rigors.  ...

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As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality? In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually ...

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Malcolm Gladwell hasn’t written much about American health care. But that doesn’t mean he hasn’t been thinking about it. And it sure hasn’t stopped many of his powerful ideas like “tipping point,” “outlier” and “blink” from gaining entry into the national health care debate. In his most recent book, “David and Goliath,” Gladwell reshaped our perspectives on the underdog and highlighted our tendency to over-value certain strengths. In the health care ...

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“Never sign anything without me reading it first.” Cautionary words from my husband, an attorney, whose ability to read and interpret the fine print has saved my life, so to speak, on more than one occasion. That all-in-the-family attitude toward a profession is something almost every doctor also knows well. Through me, my husband, relatives, friends, and sometimes acquaintances can get what I call a “healthcare quickie,” a free, two-minute sideline. They can ...

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People die without love: Why I prescribe the love drug As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love. During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the corner ...

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From MedPage Today:

  1. SGR Repeal Passes House; Patch Still Expected. A full repeal of Medicare's sustainable growth rate (SGR) payment formula hit a snag Friday, but political insiders say another temporary stay from drastic cuts in Medicare reimbursement is likely on its way.
  2. Pap Test Down but Far From Out. To take license with Samuel Clemens' words, reports of the Pap test's ...

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My friend breathed a sigh of relief as she finished her last clinic visit for the day and headed down the hall to the physician workroom.  It was only 5pm.  She still had notes to write and labs to check, and as a senior resident she needed to make it back to the hospital wards to check on her team’s interns, to get updates on the afternoon’s events and help ...

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A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic. As ...

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Recently JAMA published a special theme issue on critical issues in U.S. health care. Among the contributors was Dr. Ezekiel Emanuel, the oncologist, bioethicist and former White House adviser on health policy. In his article, “Going to the Moon in Health Care: Medicine's Big Hairy Audacious Goal (BHAG),” Emanuel argues that contemporary medicine is in need of vision, an overarching, aspirational goal "like going to the moon that can make ...

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