shutterstock_100173191 Consider, for a moment, that you are a new physician. A patient, who is a lifelong smoker, comes to your clinic complaining of shortness of breath, and after conducting several tests you diagnose him with chronic obstructive pulmonary disease (COPD). Relying on your training, you prescribe medications, arrange for follow-up visits and describe activities that can help him better manage his breathing ...

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shutterstock_185580974 Natural language processing might seem a bit arcane and technical -- the type of thing that software engineers talk about deep into the night, but of limited usefulness for practicing docs and their patients. Yet software that can “read” physicians’ and nurses’ notes may prove to be one of the seminal breakthroughs in digital medicine. Exhibit A, from the world of medical ...

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shutterstock_280962767 The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73 percent of patients were successfully treated with antibiotics or 27 percent of patients failed antibiotics and needed surgery. The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to ...

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I love that patients have so many more tools to learn about their health. Between Google, TV, magazines and the thousand-word warning that comes with every prescription, it’s almost like you don’t need a doctor. This is especially true if you do the two most important things for your health: eat less and exercise more. Except it’s not really that simple. There’s a reason it takes at least seven years to ...

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Recently, I wrote a piece on developing the state of connection within a medical family. In it, I highlighted the fact that everyone has a role in growing this connection and that everyone’s time, energy and effort is important. I also touched on the importance of parents presenting a unified front as the parental team. This piece focuses more specifically on developing that unified team approach. It can be ...

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shutterstock_164492462 Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carson told Fox News that “he's spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama's signature health care law.” Doctors hate Obamacare, it’s alleged, because it ...

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shutterstock_282279032 In the news recently has been a complaint filed by over 60 Asian-American groups, alleging discrimination in admissions at Harvard.  They point to such statistics as this: in 2009, among accepted applicants to the Ivy League, the average SAT score on a 1600 point scale for Caucasians was 310 points higher than Hispanics ...

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shutterstock_277427207 As I previously documented in a series of posts, the road to the U.S. Preventive Service Task Force's 2012 "don't do it" recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls. It led to me leaving my position at the Agency for Healthcare Research and Quality. Later, the USPSTF ...

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shutterstock_250145857 I need a new stethoscope. I have to wrap my fingers around the fissures in the tubing to make this one work. For me, these days, listening to the patient's chest is more a ritual than a means of diagnosis. After twenty years as a primary-care internist, I now work full-time in hospice and palliative care. I spend more time listening to ...

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shutterstock_269166263 We all know what the American Cancer Society, the American College of Radiology, and countless other professional societies recommend regarding screening and diagnosing breast cancer in women. But a subject that comes up far less frequently is what to do with men. While it is significantly lower than in women, a man’s risk is not nearly as low as we might ...

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shutterstock_192511037 I had the good fortune of practicing family medicine from the 70s to the early 10s. It was the Golden Age. After doing a family practice residency in a community hospital and serving a short stint as an assistant residency director, I started out in my practice that lasted almost 40 years. Here is the story of how I got the ball ...

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shutterstock_180109973 There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others. Specifically, there is a potential interaction ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old asymptomatic man is evaluated during a routine examination. He has a long history of heart murmur. With normal daily activities, he has not experienced shortness of breath, chest discomfort, or palpitations. Blood pressure is 138/78 mm Hg, pulse rate is 82/min and regular, and respiration rate is 16/min. BMI is 27. ...

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Congress is infected with the budget-cutting bug, and building an effective immune system requires political savvy. Sometimes, it’s simple (“We bomb terrorists” or “We process Social Security checks”), but sometimes an agency struggles. Case in point: AHRQ. A House subcommittee recently voted to eliminate the Agency for Healthcare Research and Quality (AHRQ) as of Oct. 1, 2015, the start of fiscal 2016. If you hadn’t heard the news or aren’t ...

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shutterstock_119953213 Recently I  read an article in the New York Times by Elisabeth Rosenthal. She’s the same author of the enlightening article, “My doctor charged me $117,000 and all I got was this lousy hospital gown.” That may not have been the exact title of the article. Following that article she wrote a follow-up about the long and difficult ordeal it ...

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shutterstock_126678482 Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside. Their physician neighbor wasn’t available to look at the child. ...

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shutterstock_65521543 The latest salvo in the interoperability and information-blocking debate comes from two academic experts in the field of informatics, and was recently published in JAMIA. In the brief article, Sittig and Wright are endeavoring to describe the prerequisites for classifying an EHR as “open” or interoperable. I believe the term “open” is a much better fit here, and if ...

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pnhp-long-setweisbartversion-52-638 In contrast to the expected shortage of tens of thousands of physicians, there appears to be an abundance of health care administrators, at least judging by graph above. The originators of the graph -- economists and physician-activists at Physicians for a National Health Program (PNHP) -- invoke the administrative bloat as reason to promote a single payer system.  With a single ...

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shutterstock_286268375 Flying on a return trip from Chicago to San Francisco, I can’t help but feel a little on edge. It’s not the fear of flying that is leaving me a little less relaxed than the pleasant, middle-aged woman peacefully slumbering in the seat next to me. It’s the possibility of hearing the announcement few doctors are comfortable hearing during travel: “Is ...

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shutterstock_256008637 I had spent medical school and the better part of my adult life in another state by the time I matched into a medical internship back home. Such an opportunity allowed me the opportunity to enjoy a more familiar setting complete with the more bucolic and relaxing lifestyle I had missed for so long. Though not quite in my rural hometown, ...

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