In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence.  Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways. Learning to unlearn In med school, learners amass an ...

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From MedPage Today:

  1. Two HCV Drugs Stronger Than One. A combination of the two newest drugs approved for hepatitis C virus (HCV) suggests that a strength of one overcomes a weakness of the other.
  2. % of Type 2 Diabetes Left Undiagnosed Declines. A lower percentage of type 2 diabetes cases is going undiagnosed than was the case in the past couple of decades.

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A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things. This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I ...

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If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly ...

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The janitor approached my office manager with a very worried expression.  "Uh, Brenda ..." he said, hesitantly. "Yes?" she replied, wondering what janitorial emergency was looming in her near future. "Uh ...well ... I was cleaning Dr. Lamberts' office yesterday and I noticed on his computer ..."  He cleared his throat nervously, "Uh ... his computer had something on it." "Something on his computer? You mean on top of the computer, or on ...

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Hegira: To take flight to escape.  To travel from a place of danger to a place of safety. “You have cancer.” You hear the words.  Your mind does not understand. “You have cancer.” Shock.  Distance.  Isolation.  Someone else.  A mistake.  A lie.  Bizarre, strange, you float above the room.  Everyone speaks; nothing is said. “You have cancer.” A fog-like curse, a venomous reality, a phantom idea.  A cold ghost foreign to the soul.  I must run. ...

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Barron Lerner thinks he understands doctor's motives.  In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science.  In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease. He states,

... cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations and ...

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Where I’m from, you can have someone killed for $5000.  I will do it for $1110. I’m a hand surgeon. I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.”   Rather, the area isn’t, but the people I treat are.  I work in a large urban referral center that has a very high proportion of Medicaid as well as ...

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From MedPage Today:

  1. A Different Take on .health Domains. Top level domains (TLD) like .doctor, .med, and .health will certainly provide for a memorable way to promote one's practice website as compared with what exists today in domain name choices.
  2. EMA Also Reviews Testosterone. The European Medicines Agency has initiated a review of testosterone therapies, joining the FDA in investigating potential cardiovascular side effects.

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It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery. Do you know where you are right now? Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon ...

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A recent ProPublica expose co-published with the Boston Globe typifies a growing gotcha genre of health journalism that portrays doctors as the enemy in a struggle for honesty and openness in medicine. These reports make unfounded leaps in their efforts to subject doctors to levels of skepticism once reserved for politicians and lawyers. They’re going to end up doing patients a disservice. For this particular hunting expedition ProPublica set its sights on ...

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The creatures cause pain by being born, and live by inflicting pain, and in pain they mostly die. –C. S. Lewis The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God. The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem ...

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Why doctors treat patients as drug addicts Fact: Doctors want to help people. Fact: Some people take advantage of doctors. A doctor in Oregon shares this case:

I had an old man with cancer. He kept complaining of pain as I was increasing his opiate pain medication, Oxycontin. I was at, I forget, about 40mg four times a day or some fairly substantial dose. I ran a urine drug test. Negative for ...

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Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. My question, however, is simple. Where is the evidence that ...

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Think for a second about the most treasured drug or device in your medical bag.  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate ... and I do. I also enjoy doing ...

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From MedPage Today:

  1. Simple, Short HCV Regimen Has High Cure Rate. A single pill once a day for 8 weeks is enough to cure more than 90% of hepatitis C virus (HCV) patients with relatively uncomplicated disease.
  2. Substance Abuse Tx Problematic Despite ACA. The nation's health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many ...

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Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception.  That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using ...

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A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education. Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier? Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate ...

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With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers. And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.) It is far ...

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There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase -- “tet chaje” -- which literally means “head charged.” More accurately, it describes a sense of being overwhelmed or conveying disbelief or frustration. Based on my limited experiences in the field, I can only begin to imagine the burnout that local providers face ...

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