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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Physicians and medical students stage a die in Recently, over 70 medical schools across the United States organized a mass “die-in” to silently protest back-to-back decisions to not indict law enforcement officers involved in the unfortunate deaths of two unarmed Black men within the context of an overall concern about systemic racism and the victimization of Black men by law enforcement. You may have seen the phrase ...

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It started with a mild case of nausea and got progressively worse. I became dizzy and shaky, but tried to ignore it. There was work to be done that afternoon. We were moving boxes into storage at my in-laws’ house in Michigan, and I needed to be strong. I carried boxes on unsteady feet, catching myself before bumping into walls. By early evening my legs were wobbly, and I felt ...

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Medical scribes are a solution to click overload A common complaint regarding the use of electronic medical records (EMRs) is that physicians spend the majority of their time with a patient “tinkering” on a computer rather than interacting with the patient. Use of EMRs is now mandatory in the U.S., creating many advantages: Patient information can be more easily shared in a secure environment, there are no lost files or ...

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Are millennial doctors ready for 21st century medicine? Are millennial doctors well trained for the 21st century? That was the question posed in NPR’s Millennial Doctors May Be More Tech-Savvy, But Is That Better? I believe how millennial doctors are educated may make them less adequately prepared than previous generations. This isn’t a reflection of medical education, but of education in general.

  • Do the technological tools available prevent the engagement needed to ...

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Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me. He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be ...

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No one wants a hospital-acquired infection -- a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak -- better termed paranoia than legitimate concern. The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, ...

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The holiday season is well underway. This is the time of year for celebrating with family and close friends and reflecting on what is truly important to us. It can also be a  time of significant stress, inevitable over-eating and deviation from our usual routines. Essentially, the holidays can be hazardous to your health and this is particularly true when it comes to your gastrointestinal (GI) system. So what can ...

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Ways to reduce administrative burdens on physicians Ways to reduce administrative burdens on physiciansA guest column by the American College of Physicians, exclusive to KevinMD.com. One of the American College of Physicians’ priority areas for the current fiscal year is to “Help ACP members experience more joy in their professional lives.” This includes decreasing what is known as the “hassle factor” ...

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Physicians must be the architects of health care changePhysicians must be the architects of health care change An excerpt  from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield). Myth 1: "The United States boasts the best health care in the world." Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the ...

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An open love letter to my broken leg This is an open love letter about my left leg. I broke it at a roller derby scrimmage in Detroit on September 6. It was my third time representing the Glass City Rollers on the road and the beginning of a long ordeal that has given me plenty of opportunity to reflect on my body and my wellness goals. Before this injury, my ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril. On physical examination, temperature is 37.5 °C (99.5 °F), ...

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Medical errors: We cant trust doctors to get it right "If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life." These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life. I spend ...

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Youre fine: Thats the hardest diagnosis to make A thought provoking article in the November, 2014 edition of Pediatrics highlights a growing problem with modern medicine: Just because we can make a diagnosis doesn’t mean we should. The article, titled “Overdiagnosis: How our compulsion for diagnosis may be harming our children,” has been made available for free to everyone. It’s fairly dense and technical, but if you’ve been following this blog ...

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Personalized medicine. Predictive medicine. Targeted medicine. These are just some of the descriptors being applied to “genomic medicine,” a field of medical research generating much fanfare and hope for the future. Genomics, according to the Centers for Disease Control and Prevention (CDC), is the study of all the genes in the human genome – that double-stranded DNA helix that defines who we are and what we’re made of. Building on ...

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One of the most pernicious lies about Obamacare is that it establishes “death panels” to ration needed care, especially care of seniors.  Although thoroughly discredited by independent fact checking sites, the death panel falsehood remains a staple of attacks on the Affordable Care Act. But it isn’t just that Obamacare doesn’t have death panels or anything remotely like them (the law actually prohibits denying benefits based on cost); we now have ...

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t’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky -- not to mention insulting -- to effectively convey the necessary information.  The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send ...

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Is there really a doctor shortage, and what can we do about it? There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The ...

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Top stories in health and medicine, December 12, 2014From MedPage Today:

  1. Tools Help Consumers Find Healthcare Bargains. Patients who used an Internet price-transparency tool to shop for laboratory tests and imaging services cut their spending by 14% on lab tests and 13% on imaging, according to a recent study.
  2. Progesterone for TBI Flops in Big Trials. Progesterone treatment failed to ...

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