Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict ...

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Urgent care wont replace primary care. Heres why. About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: ...

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This is the story.  Ebola emerged in 1976 and the last major outbreak occurred in 2007 in Uganda and D.R. Congo. Now we are experiencing the largest outbreak of Ebola ever seen with a death toll of 1,848 and number of infected of 3,707, but these are only the “confirmed” cases. Ebola is affecting 4 countries in West Africa: Guinea, Liberia, Nigeria and Serra Lione, and while we have only seen ...

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We’ve gone through four dreadful pre-medical years of learning everything from the composition of atoms to how an apple exerts force when falling off a tree.  We’ve taken a massive exam full of content mostly unrelated to our future field only to be put through four more years of intense medical education (and several additional massive exams).  We’ve managed to receive a medical degree and have gone through at least ...

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Two women, two cancers, two different pathwaysI sometimes wonder what I would do if I was told I had cancer. How much would I subject myself to in order to survive, or to achieve remission? As a parent, I can answer only that I would likely go through hell and back if it meant being there for my kids -- to watch them grow up, graduate ...

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Doctors need more quiet time After you've written on a blog for a long time, you begin to ask yourself why.  Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually ...

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As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead. This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as ...

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Top stories in health and medicine, September 19, 2014From MedPage Today:

  1. Ebola Response: Fighting the Last Outbreak? The dramatic U.S. commitment of 3,000 military personnel is arguably the biggest contribution yet to the fight against the West Africa Ebola outbreak.
  2. Microbleeds May Up Afib Mortality. The presence of cerebral microbleeds was associated with an increased risk of death from both ...

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Curbing prescription pain medication abuse by working togetherA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all ...

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This is what population health looks like It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so ...

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Many healers, teachers and parents have them. At one point, I did, too. I had delusions. I thought I was a hero, a rescuer clad in a shiny white coat and wielding the sword of clinical wisdom. I look back on those days with nostalgia and regret. I wish they'd lasted a little longer -- my belief in my own medical grandeur and invincibility. My most memorable patient changed that for me. I remember how ...

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What is HPV? HPV stands for human papillomavirus, and these viruses are the most common sexually transmitted viruses in the United States. Most of the people who are diagnosed with HPV are young and sexually active. The rates of HPV infection are high because most people who have HPV do not know they are infected because sometimes the virus shows no symptoms. Most HPV infections show no symptoms, and resolve within ...

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“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be 'too active.' Later he would tell me that it would have been “like putting a pillow over your father’s head.” These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her ...

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5 health care megatrends to watch for Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip. At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to ...

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Top stories in health and medicine, September 18, 2014From MedPage Today:

  1. I, Intern: New Questions, New Mistakes. It feels surreal to Emily Lu, MD, when she discharges patients from the emergency department at San Francisco General Hospital and tells them to see her in a month.
  2. U.S. Ebola Response: Troops, Training, Supplies. Calling the Ebola epidemic in West Africa a ...

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Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside: “He’s in v-fib.” “Get me the paddles.” The team performs urgent chest compressions for a few seconds.  Then they place the metal paddles on the victim’s chest: “Clear!”  Kathump. The patient’s heart is back to normal again, tragedy ...

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Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube -- which in Texas is technically ...

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August 17, 2010. Maris is a 57-year-old woman in excellent health.  She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law.  A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge. It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while ...

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The new VA secretary, Robert A. McDonald, speaking to a room-full of reporters, acknowledged for the first time that the department needed to hire "tens of thousands of new doctors, new nurses, new clinicians." It is now accepted that a shortage of employees directly involved in treating patients was a main driver in the waiting-list scandal that rocked the agency this year. The second, and equally important driver, was the artificially created benchmarks, that ...

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Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare & Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. Families searching for care for loved ones would have access to a familiar rating system to help them make choices. After all, star ratings for ...

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