The Affordable Care Act (ACA), commonly known as Obamacare, increased the availability of FDA-approved contraception to women through cost-free coverage under the contraceptive mandate. With the exception of some religiously affiliated insurance plans and employers who are legally exempt, this mandate supports women’s access to comprehensive reproductive health care, including the most effective forms of contraception. However, an integral part of family planning was left out of the legislation: contraceptive ...

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1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion.  The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary ...

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Up to this point, it had only been a hypothesis: That celebrity firepower can definitively drive consumer health behavior in a certain direction. The case here concerns whether women wish to embark on a genetic hunting expedition to see if they are at high risk of developing a particular disease such as breast cancer, and the motivator in this case is Angelina Jolie. The actress underwent genetic testing for mutations related ...

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Top stories in health and medicine, September 26, 2014From MedPage Today:

  1. Study: Minor Memory Problems Merit Attention. Patients who reported having lost a step mentally were at nearly triple the risk of being diagnosed with definite cognitive impairment later on, albeit with a lag of about 6 to 10 years.
  2. Chlamydia Still Common: CDC. Chlamydia continues to be the most ...

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A palliative care dilemma on the first day of the job It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician -- including a four-year pulmonary/critical-care fellowship in this very hospital -- I had just completed a palliative care fellowship. Now I was the hospital's palliative care consult attending. When I set eyes on the patient in room 1407, my first thought ...

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Where there is love there is life. - Mahatma Gandhi In this first month there is a lot I saw, learned and experienced.  Love tops the list. I became an expert in arterial punctures as I did 4 to 5 of them each day in the floors.  Each time I headed for an arterial puncture, many things automatically came to my mind: collect all of the required supplies, talk to and comfort ...

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Why do so many seemingly great technologies fail to penetrate the health care system? I hope the following five answers shed some light on the realities of technology adoption in health care. 1. Many new technologies don’t address the real problem Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it. This technique often teaches entrepreneurs a tough lesson: Technology ...

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“All your patients will die. Maybe not today, but someday.  The defining fact of life is that it ends.  Only a fool would dedicate their career to fighting something that can never be beaten.  Therefore, a doctor’s task cannot be to fight death.  A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to ...

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Over the last year I’ve written a lot about the problems with health care IT and how we need to get better. Unfortunately, unlike other aspects of our life where information technology has actually made life easier, in health care the user experience been nowhere near as smooth. IT solutions, including electronic medical records, are for the most part slow, inefficient and cumbersome. They cause a great deal of frustration ...

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Top stories in health and medicine, September 25, 2014From MedPage Today:

  1. When the Student Becomes the Teacher. Being first assistant in the operating room as a medical student influenced Sophia McKinley, MD to pursue surgery.
  2. U.S. Diabetes Rates No Longer Soaring. After years of substantial increases, rates of diabetes may be plateauing in the U.S., government data suggested.

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If I were punched by an unknown man in an elevator there would be little doubt that my assailant would be prosecuted. If the trauma were enough to cause me to lose consciousness, meaning I suffered brain trauma, my attacker would likely be charged with aggravated assault. No one would be surprised if he received jail time. No one would think twice if he lost his job. However, if I ...

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One thousand dollars per pill? A single treatment course for hepatitis C virus to cost $83,000? How can those prices be justified? The drug-discovery process is a long one, fraught with disappointments and massive investment, no matter what the outcome. Some pharmaceutical companies argue that the high prices charged for their rare “blockbuster” drugs help them recover research and development costs. While drug pricing and drug access are contentious and controversial issues -- ones ...

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Searching for health and fitness apps on the iTunes app store turns up approximately 2,200 results. There are calorie counters, activity trackers, heart rate monitors, virtual fitness coaches and every other conceivable permutation. The quantity should grow even larger thanks to Apple’s latest product release, the Apple Watch, a wrist wearable computer that tracks health and fitness information. One question, though: Are the users of these apps any healthier as a ...

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Dont spank your children. Do these 5 things instead. In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long run and research shows it’s damaging to a child’s mental health. ...

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While there are plenty of valid reasons to be skeptical about the Affordable Care Act, regardless of where you fall on the political spectrum, it’s hard to argue that imposing an individual mandate to purchase insurance won’t result in more people obtaining coverage. According to the results of a recent survey conducted by the Centers for Disease Control and Prevention (CDC), that’s precisely what’s happened. Based on results of the National ...

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The case A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: "I want to give up custody of my son." The patient is well dressed -- and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone. According to the patient, she is a single mother with no support system. Her son’s father deserted ...

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Top stories in health and medicine, September 24, 2014From MedPage Today:

  1. Key Updates for Angina, NSTEMI. The American Heart Association and American College of Cardiology released an update of their guidelines for unstable angina and non-ST segment elevation myocardial infarction (NSTEMI).
  2. Metformin and TSH: Is There a Link? Metformin seemed to further diminish levels of thyroid-stimulating hormone (TSH) in diabetic ...

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Part of a series. Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs. Those of you who have followed this series know that I am an advocate for PCPs finding ways to ...

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In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to ...

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As a recently retired physician, I still maintain an interest in medical research, though I have to ask myself: Why? Surely not just from the point of view of a potential future patient. But not from the point of view of a practicing physician either. Perhaps I keep up just from a lifetime of habit?  Or is there something I miss about my old job? These thoughts came to mind as ...

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