In a recent post, I wrote about the value of a yearly checkup with your child’s doctor -- it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips. First, and most important at all, go to the visit. You’d be surprised how often children are brought by ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old man is evaluated for a sore throat, daily fever, frontal headache, myalgia, and arthralgia of 5 days' duration. He also has severe discomfort in the lower spine and a rash on his trunk and extremities. He returned from a 7-day trip to the Caribbean 8 days ago. The remainder of ...

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California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us. I have no objection to this new requirement, if it passes. This will not be ...

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"Dad, you have the nicest patients!" She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what's important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been over ten years since I had my first "bring your daughter to work" experience.  Her first time ...

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We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. - Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst. The expression, “the devil is in the details” implies that the details can ...

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I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes. Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA). But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can't always ...

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During her annual physical exam, one of my patients recently asked me, "Are urgent care centers any good, Dr. P?" She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care -- at least some medical attention -- more imminently than she could get from waiting to speak to my office in the morning. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia. On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI ...

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Consider the messages that tattoos are sending Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle scarred chests. Occasionally, ...

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Are American doctors paid too much or too little? A version of column was published in USA Today on July 2, 2014. There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs.  I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, ...

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There are several different scenarios that I can think of in the past four years of pharmacy school that exhibit the high cost of prescription health care.  Prescription medications are constantly becoming more expensive.  Patients are unaware of their prescription benefits and how prescription insurance works.  It leads to a lot of frustration for pharmacies and patients on a daily basis.  However, every now and then there is something that ...

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Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists. (By way of diversion, I'll add there were only two of them at the time, and they were both my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply ...

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Have you ever had a situation where your perception of some event or entity changed dramatically in an instant? I specifically remember an instance of this happening to me while working as a junior medical student in a family practice clinic. It was a typical day and I was doing the typical thing that you’re supposed to do as a medical student -- feign interest in the clinic’s goings on and try ...

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This is a simple plan that would empower patients, improve the lot of primary care physicians and likely hold down medical costs while improving quality in the health care system. I would first like to present the plan, then elaborate on how it could accomplish the above objectives. The first part of the plan would set aside a portion of each person’s health care dollars (i.e., insurance premiums) and place it ...

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

  1. NSAIDs May Slow Breast Ca in Obese Women. Obese women with estrogen receptor-positive breast cancer had a 52% lower risk of recurrence when they regularly used aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
  2. Mix of Kudos and Caution for Fecal DNA Test. Approval and imminent Medicare coverage of a ...

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I wish I had a dollar every time someone gets misty-eyed about the physician-patient relationship -- and two dollars every time they say protecting it is the key to health care. That might be true, if you thought health care was awesome circa 1960. Hereʼs what the physician-patient relationship meant back then: Physicians say, patients pay. We have seen little progress since then. The claim that the relationship is now symmetrical ...

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Chest pain and what we can learn from changing flat tires “Daddy, I think we have a flat tire.” I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting. How could she possibly know what a flat tire sounds like? Now? Right now? She’s ...

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We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over. It doesn’t matter whether the physician ...

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You may find this story hard to believe, but it's true. A 75-year-old non-smoking man with no serious medical problems and a relatively low-risk family history (father, a life-long smoker, died of a stroke at age 76) has been undergoing routine physical examinations by his primary care physician in Florida every 6 months for several years. The visits include a full battery of laboratory studies, nearly all of which have been completely ...

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Drop doctorspeak and get real with patients If you’re a doctor, I bet you speak doctorly. You act doctorly. And dress doctorly. And spend your days in clinic with other doctorly doctors. But life is what happens while you’re busy staring at computerized flow sheets, algorithms, and billing codes. Real life happens outside of man-made medical institutions. Patients live in the real world. And I always wanted be a real ...

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