16 questions to ask when choosing a hospice Hospice is a set of services that we all may need someday -- if not for ourselves, for our parents. While death is not an option for any of us, we do have choices about the services we use at the end of life. Hospice is undoubtedly the best option in the last months of life because it offers a whole ...

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Recently, someone asked me on Twitter, “Has the change in classification of obesity as a disease affected how you treat patients presenting w/ the disease?” The classification change in question is regarding the American Medical Association’s declaration that obesity is a disease rather than a comorbidity factor. This change in classification affected 78 million American adults and 12 million children. The new status for obesity means that this is now considered a ...

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A pivotal moment in the U.S. health care system is taking shape. Physicians across the U.S. are wondering what their role will be in this new health care landscape that is being shaped by legislation (from the Affordable Care Act and from meaningful use), by social media, and by technology advancements. It’s an existential moment. Physicians are wondering if we are knaves, pawns, or knights in this chess game called the ...

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It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient-doctor relationship continues to mount. Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, ...

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A 35-year-old woman is evaluated for new-onset thrombocytopenia. She is gravida 1 at 36 weeks' gestation. Her pregnancy has been otherwise uncomplicated. She takes only a prenatal vitamin. On physical examination, temperature is normal, blood pressure is 110/65 mm Hg, pulse rate is 110/min, and respiration rate is 22/min. There are no ecchymoses or petechiae. Abdominal examination discloses no right upper quadrant pain. She has a gravid uterus. Neurologic examination is ...

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The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation. In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan. Yet our measurable health outcomes -- from infant mortality to life expectancy -- aren’t any better than nations spending much less. I’ve written about this paradox before, pointing to a few ...

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In my line of work, it's not uncommon for a civil debate about the evidence for a cancer screening test (such as the PSA test for prostate cancer) to rapidly degenerate into the other person questioning my motives or suggesting that the real reason I oppose disseminating or requiring insurers to pay for a test is because I secretly want patients to suffer lingering and painful deaths. ("He obviously doesn't care about ...

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HealthKit and the Health app: A game changer for doctors? Several months ago I wrote about how Apple’s upcoming health app had the potential to change public health and could force physicians to adopt mobile. Recently at WWDC Apple affirmed the rumors when announcing iOS 8, stating the new operating system would have a Health app, and a cloud platform HealthKit. HealthKit is the developer platform and will be able to collect/aggregate  information ...

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I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. A recent piece in JAMA and the editorial that 
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Live tweeting from conferences has become very popular, but I'm not sure why. The biggest problem is this: Lucid communication of a point made by a speaker using more than 140 characters at a time is difficult to capture in a tweet. The tweets tend to be filled with obscure abbreviations and references to previous tweets that may seem quite clear to the tweeter but not the tweetee. Some also post ...

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I was on the cusp of my first year in medical school, and time was running out. Classes started in two weeks. I needed a place to live: Ideally someplace cheap, not too far from school. There was an opening at Phi Chi medical fraternity, a large brick house of faded elegance located less than a block from my classes at the University of Minnesota. At $75 a month for a ...

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Top stories in health and medicine, June 27, 2014From MedPage Today:

  1. Shortage of Saline Has Hospitals on Edge. Hospitals across the country are struggling to deal with a shortage of one of their essential medical supplies. Manufacturers are rationing saline -- a product used all over the hospital to clean wounds, mix medications, and treat dehydration. Now drug companies say they won't ...

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As a parent, my words to and about my child will probably be one of the single most influential aspects of their development. Children learn to see themselves through their parents’ eyes, and what we tell them they are, they are likely to become. The labels we place on them often tend to be a self-fulfilling prophecy. I’ve seen this play out in my own life and in the lives of ...

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ZDoggMD with another classic parody: "Let it flow."  As he puts it, "an emotional, epic anthem ... about urinary retention." Men with BPH rejoice!

Youre doing it wrong: The Paleo diet Go ahead, eat more meat, butter and cheese. Let me know how it turns out for you. I certainly won't be joining you, despite the current popularity of the proposition. For one thing, there is no case -- none -- that eating more meat, butter and cheese would be good for us. Rather, the case is advanced these days -- 
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I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa deferentia.  In other words, could my patient, a 42-year-old ...

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We all want the advantage.  We put our kids in special preschools so they have the advantage.  We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told.  Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1. UnitedHealthcare (UHC) will be
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It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look. The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered ...

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Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, "Are Children Overmedicated?" seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase prescribing of medication.  In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy ...

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

  1. Drug Discounts Have Pharma Crying Foul. In 1992, the federal government told drug manufacturers they had to give steep discounts to hospitals that treat a large percentage of poor patients.
  2. Quitting Snus After MI May Lower Death Risk. Stopping the use of smokeless tobacco after a myocardial infarction (MI) ...

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