I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath. He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he ...

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If you are a doctor, nurse, patient, or just someone interested in patient safety, you should read a five-part story called "The Overdose: Harm in a Wired Hospital" excerpted from a book The Digital Doctor by Dr. Robert Wachter. Dr. Wachter and the hospital are to be commended for publicizing this incident so others may learn from it. The hospital staff, the patient, and his mother, also deserve credit for allowing their ...

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A variety of factors contributes to the challenge. First, even in this era, in which autism is a household word, it is not unusual for me to give the diagnosis to parents who have not considered the possibility that their child has autism. Statistically speaking, the children we see at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center for these initial evaluations are very young -- on average, 24 months ...

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The riots in Baltimore are all over the news. As a parent, it would seem like the best thing to say to your kids is that riots are bad, that violence isn't the way to solve anything. But that would be missing the point -- and missing an opportunity. Don't get me wrong; I don't think that riots are good or that violence is the way to solve things. But what is ...

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The recent killing of Walter Scott was another brutal reminder of the home African-Americans wake to daily. Their America, is one where your father might not come home at night, because his brake light went out, and that cost him his life. It's a place where petty crimes are penalized by life sentences, doled out on the streets by the very men and women charged with their ...

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JAMA published an opinion piece about the controversial issue of patients secretly recording their physicians during encounters.  We live  in the era of the smartphone.  Everyone has one -- soccer moms, teenagers, young kids who can't even read yet, elderly nursing home patients who can't safely feed themselves.  Everyone.  And these devices have amazing powers of audiovisual capability.  We all know this.  Anyone can film or record anything at any time.  ...

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It has been known for a long time that “health care” -- all the stuff that we do, prescribe and provide -- is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care. I ...

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In the old days, blockbuster drugs were moderately expensive pills taken by hundreds of thousands of patients. Think blood pressure, cholesterol and diabetes pills. But today, many blockbusters are designed to target much less common diseases, illnesses like multiple sclerosis and rheumatoid arthritis or even specific subcategories of cancer. These medications have become blockbusters not through the sheer volume of their sales, but as a result of their staggeringly high ...

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asco-logo She was so young -- only 32 when diagnosed with ovarian cancer. She had given birth to a son only four months earlier and by all rights should have been celebrating being a new mother. But, instead, she had developed acute pelvic pain, undergone emergent removal of her uterus and ovaries, and was now in my office to discuss ...

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shutterstock_132966002 As a wife and mother, I have days that are very difficult, especially since my husband is in training. I go several days in a row where I only see him right before bedtime, and some days he is unable to see our son at all. I often feel like I have no control of our schedule, and am lucky to ...

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medpagetodayFrom MedPage Today:

  1. ACP Prefers Cervical Cytology Over DNA Screens for Young Women. The American College of Physicians (ACP) said Pap smears should be the mainstay of cervical cancer screening in normal-risk women younger than 30, with molecular testing for human papilloma virus (HPV) reserved for older patients only.
  2. FDA Wants Data ...

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I'm proud to introduce the KevinMD minute, where I share my thoughts in 1-minute videos.  They will be shared first on my YouTube channel. Below is a transcription. Enjoy. Which social media platform should doctors use first? My recommendations are LinkedIn or Doximity. These are professional social networking sites where a profile on one of these sites is no more than a digital translation of your résumé. There are some ...

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shutterstock_151206914 A few weeks ago I wrote a piece about performance metrics in medicine.  People asked me:  “Well, if you don’t like the metrics, what would you use?”  So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education. Standardized testing has become ubiquitous in schools.  ...

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I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have ...

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It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year. About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with ...

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While reading the book Lean In by Sheryl Sandberg, I was mesmerized by her insight about the self-perpetuating difficulties women face during their careers; however, something was missing. Mrs. Sandberg, the COO of Facebook, wrote an enlightening novel about the differences in mindset between the genders and how this hinders women in their career. I found that she was spot on with my experience as a woman pursuing medicine. Like Mrs. ...

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I recently discussed both the merits and needs for the use of mobile technologies in clinical trials. Recruiting patients via social media is now a reality and has been a topic of discussion in many forums, including mainstream medical journals.  There is no question that online patient support groups serve unique purposes. There are regulatory issues involved in this arena. However, new regulatory frameworks need to be developed in the age ...

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I just finished reading the Journal of Hospital Medicine article called “The highest utilizers of care: individualized care plans to coordinate care, improve health care service utilization, and reduce costs at an academic tertiary care center.” Using a multidisciplinary team of volunteers including members from hospital medicine, ER, psychiatry, ambulatory care, social work, nursing and risk management,  individualized care plans were developed for high utilizer patients.  These patients had multiple ...

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medpagetodayFrom MedPage Today:

  1. Is This 'Meaningful Use'? Docs Say Yes, Patients Unsure. Proposed changes to patient engagement requirements under the federal government's Meaningful Use program are drawing praise from physician groups but are disappointing patient advocates.
  2. Point: Does the Risk of E-Cigarettes Exceed Potential Benefits? Yes. The use of e-cigarettes continues to ...

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We have all seen the statistics; America is an aging country. The baby boomer generation is retiring, and families are having fewer and fewer children. In health care, we often hear about this issue in the context of an inadequate health care workforce. An aging population in conjunction with the ACA has created a quickly growing pool of patients that outpaces the slow growth in the supply of health care providers. But ...

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