Old age is no place for sissies. -Bette Davis “I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!” She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had ...

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In just the past six months months we, the medical community, have been challenged by questions regarding the torture report, #ICantBreathe and #WhiteCoatsForBlackLives hashtags, Ebola research and treatment, the ALS ice bucket challenge, deaths of Brittany Maynard and Joan Rivers, and the Hobby Lobby case.  What these events have in common are not their scientific or molecular underpinnings, but rather their push for us to reflect on the current state ...

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Today was (almost) the last straw. If you've read this column before, you've listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care. This one today takes the cake. Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, ...

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Top stories in health and medicine, December 17, 2014From MedPage Today:

  1. Gene Test Has Promise for Nailing DCIS Recurrence Risk. A multigene panel predicted recurrence risk in ductal carcinoma in situ (DCIS), according to a population-based study.
  2. Docs, Guns, and Smokes. One day in clinic, 2 years ago, a patient handed Adam Goldstein, MD, MPH, a request for a concealed ...

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She screamed when her boyfriend hugged her. Why? I was checking my email when it happened. My boyfriend had texted me saying that he was late arriving to the airport. So I stood outside with my suitcase behind me and clicked to an email from my mother. I didn’t notice until too late that someone had approached me, and I screamed when I saw a black man reach out to ...

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Unfortunately, measles is in the news again. Measles is a very contagious viral illness that causes a high fever, rash, cough, and a runny nose. Complications include pneumonia, brain inflammation and death. Prior to 1963 there were hundreds of thousands of measles cases in the U.S. annually, causing hundreds of deaths. In 1963 the measles vaccine was introduced, leading to an immediate decrease of measles cases in this country. In 2000 measles was ...

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The American hospital as we know it is in peril I appreciate the need for physicians and others to sleep.  I’ve spent a great deal of my career awake in the wee hours.  In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians.  But I fear we’re all wearing a little thin.  Because the emergency room has become ...

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What I learned from the next generation of doctors “So this is Christmas, and what have you done?” John Lennon sang from my nightstand, waking me out of a deep slumber. Bleary-eyed, I pondered his question: What have I been doing all year? A decade ago, my conversations with my younger brother, went something like this: “Do anything but medicine for God’s sake, save your soul, man!” He’s now an emergency room doc. ...

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How to fix maintenance of certification: Heres what Id do There's a lot of angst when it comes to board recertification.  The general consensus is that doctors find the requirements onerous, while a more cynical segment calls the whole process a money-making operation for our professional societies and those that profit from recertification courses and materials. Cardiologist Wes Fisher has articulated the many criticisms against board recertification: "Does board recertification do ...

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After prostate cancer treatment: What about intimacy for men? I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first -- my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on ...

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Top stories in health and medicine, December 16, 2014From MedPage Today:

  1. Painful Hands, Hurting Hearts? Symptomatic osteoarthritis (OA) of the hands was associated with an elevated risk for coronary heart disease events, analysis of data from the Framingham Heart Study showed.
  2. Can Social Media Aid Public Health? Here's an angle Mark Zuckerberg has probably not yet mined: restaurant reviews and ...

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Why hospitals have to dramatically change their missions I think I will become a neurosurgeon. Tomorrow. It shouldn’t be too hard, right? I’m a breast cancer surgeon, and that is kind of like being a neurosurgeon, isn’t it? I wear scrubs and know how to tie knots really well. OK, maybe I don’t know much about the brain, and the last time I was on a neurosurgical team was during ...

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Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death. Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. ...

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Mr. B shook my hand as the paramedics got the stretcher ready to send him to a nursing home. His firm grip punctuated the end of a long hospitalization, which had been characterized by several decisions to leave the hospital against medical advice into extremely unsafe situations, leading into complex capacity evaluation decisions. It was a pleasure to take care of you, I told him. He smirked back at me and ...

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She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding. People ...

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Direct primary care: Setting the record straight Since starting a direct primary care (DPC) practice nearly three years ago, I've become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it's difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice. Two common concerns about DPC have emerged during my conversations with fellow ...

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She died thirsty! Ice chips matter when it comes to patient satisfaction. “My wife died uncomfortable and alone. She died thirsty!” The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to ...

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Top stories in health and medicine, December 15, 2014From MedPage Today:

  1. ED Throughput: A Fixable Problem. As I travel the freeways of the various cities I visit, I often come across billboards announcing waiting times at the local ED, or billboards promising no wait at all. Sometimes they just advertise "faster" care, whatever that means.
  2. Mumps Checks NHL Players. It ...

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Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care -- some of it mine -- being foisted on patients. At one point in my career, I would ...

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I keep six honest serving-men (They taught me all I knew); Their names are What and Why and When And How and Where and Who. - Rudyard Kipling Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done. What else could explain why IT people tell doctors what “workflows” ...

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