Neither of the two most important people in Aaron's life could stand to be in the same room with each other.  There was a long colorful history between his ex-wife and his brother, and as his disease began to accelerate, the feuding became quite intense.  They argued over Aaron's advance directives.  They both tried to coerce and manipulate themselves into commanding positions.  The shouting became louder, the fury more fierce.  ...

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Short-of-breath, weak, in pain.  Cancer -- aggressive, cold, unfair -- ravaged Roger’s body.  But maybe, just perhaps, there was a modern medical miracle.  A drug.  A single daily pill to attack the genetic growth switch in each malignant cell.  Only, there was a problem.  Not a big problem, really, but possibly fatal.  The kind of real life annoyance of living in a modern medical miracle society.  The co-pay cost to ...

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As survival rates for pediatric cancer continue to improve, more and more pediatric practices include children who have been treated for cancer. Some patients are making the transition back to primary care after finishing their cancer treatment. Others are only a few years post-treatment and still being closely monitored for recurrence. Still others have survived five years or more and are considered cured. Whatever their circumstances, these patients can present ...

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With the endless appearance of medical malpractice solutions in the press, any reader would think we have the answers to the logjam -- but no will to implement them.  If you follow the topic, you know every proposal has flaws and limited applications as they relate to individual states or delivery systems. The worst offender seems to be safe harbor protections (i.e., “follow the guidelines and you won’t get sued”). Recently, however, I ...

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“Failure is not an option," people sometimes say. I don’t agree. I certainly have failed far more often than I have succeeded when I sought to do novel risky business adventures and/or create new products.  Without failure, I would never have learned the lessons of life or the lessons of business necessary to succeed in these spaces. As a physician and surgeon, I can tell you that failure is part of ...

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At the outset of this process of becoming a doctor, a friend and mentor of mine, a professor emeritus of medicine known as a mentor who cares deeply about his students and for his New England style dinner parties, sat me down to explain the gist of medical school. The first two years, he explained -- bowtie notwithstanding -- are the equivalent of studying a language from textbooks. You must first ...

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When we perceive any object of a familiar kind, much of what appears subjectively to be immediately given is really derived from past experience. - Bertrand Russell, The Analysis of Mind I’ve learned a few more things about Stephen Pasceri, the man who murdered a cardiovascular surgeon in Boston recently.  He had money troubles involving credit card debt.   He declared bankruptcy at one point.  He tried to get John Kerry, the senator, ...

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Whenever I am asked this question, I can't help but think of the punchline to a joke that was once supposed to be funny but would now be considered beyond the pale in all respects, so I won't repeat it. The punch line is: “Just lucky, I guess.” That's the short answer to why we gastroenterologists work in our field. Despite the distasteful aspect of human waste and the perverse ...

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I felt out of place. It wasn’t the dull yellow flickering fluorescence of the hospital lights greeting me well before dawn. It wasn’t the photos of world-renowned surgeons lining the hallways as if monitoring my every step, or that some of those same surgeons were close by rounding on patients. It wasn’t the sea of dark suits swarming around me vying for a prestigious residency position. It was something far ...

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The nationwide shortage of physicians is a very real crisis across all 50 states, causing a huge strain at all levels of health care. Hospitals and clinics are struggling to hire, current physicians are overworked, and ultimately patients have to wait longer. There are a number of reasons why this has happened, but one thing’s for sure: With the aging population, the problem is only going to get worse. One estimate from ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Before undergoing surgery, you should carefully discuss your medications with your surgeon and physician anesthesiologist. You may fare better during the operation and the early recovery phase if you continue required medications, but you might need to avoid some medications that could interfere with your anesthesia. Three ...

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Medicaid A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e., on average, she makes less than minimum wage when treating a patient on Medicaid). The enthusiasm for expanding Medicaid coverage to the previously uninsured ...

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My mother is a very smart woman.  I see it in the way she solves problems, creates complex crafts, and navigates hard conversations. She can't, however, add fractions. She was never very good at math, she says. "I was never very good at math" is a dirty phrase that garners much attention in my household.  My husband, a sixth-grade math intervention teacher, spends just over 170 days each year attempting to ...

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Yikes:

The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.
Holy crap: They’re really doing it. Or trying to do it. Who the hell knows what they’re trying to do? Not “them,” that’s for sure. The United States government via the Department of Health and Human Services is going to start trying ...

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As physician burnout becomes more widespread, it’s time to think about the future. Do you have people asking you if you would be a doctor again? Not a week goes by without me being asked by either a medical student or a practicing physician: Do you recommend medicine to others? Or is physician burnout too rampant, too overwhelming, too all-consuming? That’s one of those super loaded questions. And it doesn’t have an easy answer. Here’s ...

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All physicians know the scenario. You want to reassure the patient; the patient wants another (usually expensive) test. In our new metric age, we may have a conflict between overuse and patient satisfaction. The article provides some hospitalist data: "Hospitalists know guidelines but overuse tests to reassure selves, patients." How do we balance making our best evidence-based decisions with patient demands? Some experts will tell us that we really have a ...

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In the midst of seeing a patient, I got a call from another physician, my dad's new cardiologist. "Looks like he is going to need CABG (open heart surgery) since he has four major blockages." I was expecting this call, and this result, based on his history of diabetes and at least one month of chest pain. It was still shocking to hear. I walked back into the exam to continue the ...

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First off, this is the first time I have typed an official response to a blog post: "Dear health IT: Please understand our frustrations."  You might think, hey aren’t you a millennial, shouldn’t you be blogging non-stop?  Like doing everything from my taxes to baking with my smartphone?  No, not really; besides residency doesn’t make it very feasible either. Yet, the need to respond to Dr. Leap’s blog post was ...

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Millions of people are diagnosed with irritable bowel syndrome (IBS) every year making it one of the most common gastrointestinal (GI) conditions. Despite its prevalence, there remain many misconceptions about IBS among both patients and doctors. Here we review some basic concepts in hopes of demystifying this nebulous syndrome. What is IBS? Irritable bowel syndrome is defined by a constellation of symptoms including abdominal pain and altered bowel habits (diarrhea or constipation) ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old woman is seen for a follow-up evaluation of Parkinson disease, which she has had for 12 years. She was initially treated with ropinirole to which levodopa-carbidopa was added as the disease progressed. After 5 years of good control on medication, she began to experience involuntary generalized twisting and writhing movements ...

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