When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked.  My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work.  Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward ...

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The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t. The U.S. lags behind other industrialized nations in many important health measures -- partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious -- but we’ll explore some ...

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An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort ...

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medpagetodayFrom MedPage Today:

  1. OA Patients Don't Face Higher Heart Disease Risk. Neither radiographic nor clinical osteoarthritis (OA) was related to a greater risk for cardiovascular disease (CVD) in older patients.
  2. Senators to Providers, Industry: Lobby Harder on End-of-Life Care. A strong coalition is needed to transform care for the dying, said U.S. ...

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As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies. As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is an exception that can make you realize that there ...

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Eonia I Mnimi (Eternal Memory)  - Greek Orthodox Funeral Blessing “Have you ever seen anyone die before?” my cousin asked me, from across the bed. “Sure I have, plenty of times,” I answered. We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath. *** My uncle had been declining for several years with 
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I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked. I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at ...

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When he and I first met, he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!” I did. The next week, he answered my questions about the pencil drawings on his walls. “My name ...

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As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of neurohormonal changes that work in concert to nudge the ...

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Ever heard of a doula? Doula is an ancient Greek word that translates as “woman who serves.” Specifically, it’s come to mean someone who serves as a birth attendant, a person trained in childbirth who acts in support of a birthing mother. A doula provides knowledge, comfort, and an extra pair of hands -- whether it’s to provide nourishment or massage, or help a mother find a comfortable position. As you may ...

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medpagetodayFrom MedPage Today:

  1. Retooling the Health Hazard Survey. "Oral sex? Anal sex? Fetishes?" These are questions on the patient intake form at AlphaBetterCare, an LGBT-friendly primary care practice owned and operated by Howard Grossman, MD.
  2. Orthopedists' Financial Conflicts Can Hurt Patients, Surgeon Says. Financial conflicts of interest often drive physicians to perform ...

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Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession -- usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor may be in and out of the room in ...

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I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab, waiting to see our cadaver for the first time. Our group enters, and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy ...

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In late January, government officials announced a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services.  As Medicare goes, so go private insurers; this makes the agency’s move toward quality-based reimbursement nothing less than a sea change. It builds momentum for a view of health and health care that is integrated and holistic, rather than comprising discrete, disjointed episodes of treatment. This ...

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After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient's estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline's new risk calculator had not been validated ...

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I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S.  To be a top seller, a drug has to be expensive and also widely used.  Abilify is both.  It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill.  Annual sales are over $7 billion, nearly a billion more than the next runner-up. Yes, you read that right: $30 a pill.  A little more ...

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A couple of years ago, I asked a friend of mine how she met her husband.  It was at a bar, and when she asked his occupation he replied, “I work for the city.”  She took that to mean he was a construction worker.  They began dating and quickly fell in love.  Much to her surprise about a month into their relationship, she learned he actually played for the NFL ...

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medpagetodayFrom MedPage Today:

  1. Match Day Hits Record High Numbers. I wasn't sure where I was going to open my Match Day envelope on March 20. Sealed inside was information about where I would be completing my internship in internal medicine and residency in physical medicine and rehabilitation.
  2. How Will PROMISE Change Practice ...

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In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by in the Washington Post:

Critics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.
Doctors prefer to ...

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Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t. He spoke rapidly with a slight ...

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