I like a lot of things about Facebook. It allows me to see pictures and video of my nephews and niece and of friends’ children, it quickly lets me know when something big (either happy or sad) is going on in people’s lives, it lets me know what people are thinking about, and it gives me the opportunity to share my own news, thoughts, pictures, or occasional videos with others. But as much as ...

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The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today. A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and ...

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Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden. In this particular conversation, ...

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I recently presented my diagnostic talk -- Learning to Think Like a Clinician -- at the Virginia ACP meeting.  Afterwards several physicians wanted to discuss the reasons for diagnostic challenges.  They convinced me that many regulations from CMS and other insurers have influenced policies that increase anchoring and diagnostic inertia. When the emergency department physicians admit to the hospital, they have to give an admission diagnosis.  At least in the United ...

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In a recent article, Malcolm Gladwell dissected and diagnosed American health care. Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint. But it was his closing comment that caught me off guard. When I asked Gladwell what ...

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As a pediatrician, I encourage families to search online for health advice. Yet how you search and where you click matters. Tips for you and your time with “Dr. Google” or “Surgeon Bing.” The Pew Internet Project’s research finds that over 70% of Internet users in the United States say they have looked online for health information in the last year. Furthermore, most health information seekers (ie freaked out parents searching ...

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From MedPage Today:

  1. Water Labor OK, Water Birth Risky, Groups Say. Immersion in water during the early stages of labor might benefit mothers-to-be by decreasing pain and shortening delivery times, but giving birth in water has no proven benefits and poses potentially serious risks to the baby, according to a statement from the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists ...

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As a medical student, I am being taught not to judge patients. If a patient tells me that he has smoked cigarettes for forty years of his life despite the protests of his wife, I am supposed to nod my head understandingly without showing my inherent disapproval. If a patient tells me that she has given her husband genital herpes because she is cheating on him, I am not supposed ...

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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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