Oft expectation fails, and most oft there. Where most it promises. - Shakespeare, All’s Well That Ends Well It may seem a strange thing to say, but I believe the U.S. suffers from unrealistic expectations. We expect government, health, and hospital officials to get things right the first time around. This is unrealistic. People, and believe it or not, including politicians, are never perfectly competent in things they are never experienced before. Disease ...

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Top stories in health and medicine, October 28, 2014From MedPage Today:

  1. Genes Confirm LDL Causes Aortic Stenosis. High LDL cholesterol appears to cause aortic stenosis, even though lipid-lowering trials in established valve disease haven't worked.
  2. Genetic Tests Dominate Thyroid Meeting. The competition for top genetic test for indeterminate thyroid nodules continues at this year's American Thyroid Association meeting.

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A month ago I published a post predicting that paramedics, emergency nurses, and emergency physicians would be exposed to patients with Ebola and have difficulty picking out these patients from the many other patients who present to the ED with similar symptoms. In light of the events in Dallas, Texas, this seems prophetic, but it is really not so difficult to explain ...

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What can be said about the Generation Y physician? Tech-savvy.  Attention-craving.  Lazy, good-for-nothings. These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century.  Commonly known as Generation Y, this demographical cohort of 20- to 30-somethings has certainly sparked mixed reviews from its Gen X and Baby Boomer elders. But what defines the particular subgroup of young ...

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What is social media's ROI for doctors? I created this 90-second video for my CHEST 2014 keynote that tells the story of two of social media's returns on investment: defining an online reputation and finding new patients. Enjoy.

Although I never disclosed this in my medical school interviews for fear of being just another cliche ("Hollywood sparks interest in medicine story"), I decided to become a doctor in 1997 at the age of 11 when I first saw the movie, Outbreak. For years and years, this was my favorite movie. The scene where they showed the electron micrograph image of the Ebola virus had me captivated. I was staring at ...

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Ebola in the digital age: How doctors can confront it With the recent attention given to the Ebola outbreak in West Africa and the cases diagnosed in the United States, one of the main ways in which the public is being informed is through social media. Every single day on Facebook, I see at least one story posted about the Ebola epidemic and its potential impact on the U.S. public and ...

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The Affordable Care Act (ACA) has created an unprecedented opportunity to improve the well-being and economic security of millions of Americans, including lesbian, gay, bisexual, and transgender (LGBT) people and their families. Notably, health care reform has the potential to reduce and eliminate LGBT health disparities by improving access to quality, affordable health insurance coverage that connects LGBT individuals and communities with the care they need. However, this opportunity ...

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What happens when your faith, commitment and professional integrity collide with great personal risk? This is what I imagine is happening across the country to physicians, nurses and other health care workers as we all face the Ebola tragedy. Sure, people dying in far away Africa bring an ache to our hearts. Admiration for those working with aide groups  brings the passing thought so easily conjured from the safety of our ...

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

  1. Nurse Beats Ebola. Fourteen days after she felt her first symptoms, Nina Pham, RN, has conquered Ebola.
  2. 'Bad' Fats Down but Not Out of Diets. Trans and saturated fat consumption have dropped, but not far enough to meet recommended levels for heart health, and omega-3s have plateaued too low.

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Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination. One of the most frequent complaints in my email box these days is a sense that the current record is filled with data, but little knowledge and ...

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Ebola is frightening but not for the reason you may imagine. A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths.  As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department.  I left that day inspired that I had the education and training to ...

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 Patient perceptions of the hospital experience Patient perceptions of the hospital experience An excerpt from Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way. Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use the word experience in their comments: “I can’t believe how ...

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Want to know why residents dont chose primary care? Read this. I just got a taste of improved access, and I gotta tell you, it sapped my energy. It reminds me of the old standup comic one-liner, "I just flew in from Vegas, and boy, are my arms tired." Today was the department of medicine housestaff picnic (pretty much a guarantee to cause the weather to change from clear skies to rain), and so ...

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Recently, Apple introduced its newest product, the Apple Watch. According to Businessweek, Apple spent years researching watches before deciding to build one. The company flew watch historians to California and they worked to understand how wristwatches have traditionally been used, and how a new “wrist computer” might work. They have hired leaders from diverse backgrounds -- none of them techies -- to lead these efforts. It struck me that health care could learn ...

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Suicide puts the medical profession in a difficult position Recently, I wrote about the importance (and difficulty) of maintaining a healthy lifestyle as a resident. Now, I’d like focus more specifically on the toll that residency -- and in general, a career in medicine -- takes on a health care provider’s mind and soul. As you may have heard, in August two young physicians decided to end their lives. No one can ...

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Recently at our community hospital, after we concluded a nearly two-hour standing room only Ebola preparedness meeting, I practiced donning and doffing the personal protective equipment (PPE) for Ebola cases. PPE is the protective wardrobe health workers wear when examining a patient with a contagious infectious disease. Each disease has a different level of transmission and requires an appropriate level of protection. I wear gloves 25 times a day to examine ...

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Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition. Pardee UNC Health Care is implementing a new nursing protocol that puts nutrition at the center of the care team and the locus for reducing readmissions, pressure ulcers and lengths of stay. Pardee’s efforts come as more and more studies document the seriousness ...

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It has been 5 years since the passage of the HITECH Act portion of the Affordable Care Act. The purpose of HITECH was "to promote the adoption and meaningful use of health information technology." While the result of this legislation has been the significant increase in the adoption of EHRs, most of the potential benefits of digital technology have yet to be demonstrated. there are multiple reasons for this lack of proof. The ...

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A few years ago, I was doing a summer internship in which I looked at health outcomes for hospitalized patients. I sat in an office and read about patients with issues like high blood pressure and cholesterol. At a certain point, I realized that the reports on their outcomes were interesting, but the real solution to the problems I was studying was happening outside my window. My window overlooked a ...

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