The study you never heard of: Small practices arent dead yet According to a new Commonwealth Fund sponsored study published in Health Affairs, “Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions.” The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide ...

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My patient suddenly leaned forward, swung her hair up, and began to push it this way and that, determined to find and show me the partitions that her hair made when rested in a new equilibrium. It was a warm Thursday afternoon and we were in dermatology clinic. This 20-something young professional had come to have her scalp examined. She'd noticed a sudden increase in the quantity of hair follicles that ...

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Hospitals should not control the decisions of pregnant women Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability. The case involved a 39-week-pregnant woman. According to a Read more...

Top stories in health and medicine, September 5, 2014From MedPage Today:

  1. Potent Statin Offers No Help After Cardiac Surgery. The powerful lipid-lowering drug rosuvastatin (Crestor) -- also purported to be an effective anti-inflammatory agent -- was powerless to prevent postoperative cardiac surgery complications such as atrial fibrillation.
  2. Questioning Medicine: The Pain Management Fiasco. I spent my intern year at a ...

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While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine. But that is me, is it you? A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going to live a sad and angry life. Happy doctors ...

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It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences. I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K.  Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training.  Like most urban ERs, this one was a busy place ...

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One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I ...

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Does owning cancer equipment change treatment patterns? Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment. For people living with cancer, this kind of bias can have a particularly painful impact. Radiation therapy brings out medical bias In the United States, cancer is the second most common cause of death, killing nearly 600,000 ...

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An orthopedist asked me if I could explain why a couple of papers of his did not generate any feedback. He wasn't even sure that anyone had read them. He enclosed PDFs for me. Not being an orthopedist, I cannot comment on their validity. But I think I can explain why the papers have not created much interest. Are you familiar with the term, "impact factor"?

A journal's impact factor is an ...

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Sometimes my day is like a book.  The first chapter may begin in the darkness of a self imposed corner as a phone call is made.  A voice, full with the thickness of slumber, answers unexpectedly. "I think today is the day." No matter how many years I have been discussing death I still find myself using poor euphemisms.  The bane of medical school teaching, I often struggle with the directness.  "Your mother ...

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Top stories in health and medicine, September 4, 2014From MedPage Today:

  1. Battle Over Abortion Clinic Restrictions Heats Up. The nation's fight over abortion continues unabated, but the battleground has shifted -- instead of seeking to limit who can obtain abortions, the latest legal attacks on abortion now focus on who can perform them.
  2. CDC Head: Ebola Likely to Worsen. The ...

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We are, I trust, all but universally familiar with the knee jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response. The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet is transmitted to the spinal cord, and the ...

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The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000. To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us? In most consumer ...

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I see nearly 100 patients a week.  Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30.  I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity.  There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the ...

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If an ill patient, who unexpectedly has Ebola, landed in Memphis, it is likely that my partner or I would see him. We work as infectious disease doctors at the hospital closest to the airport. The Ebola patient would present with fever, nausea and vomiting, indistinguishable from a flu or a viral illness that hundreds of patients present with each day at our hospitals. But over a few days of the illness, ...

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That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles even if much of the public remains unaware. Recently, two Department of Health and Human Services (HHS) researchers posted new findings on the Medicare and Medicaid Research Review, a peer-reviewed online journal supported by the Centers for Medicare and Medicaid Services (CMS), documenting how some insurance companies are overbilling the government and have been doing so ...

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I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir, I read about your unique practice online.   I have an 91-year-old ambulatory father who will not go to a doctor.  He definitely is not well and this is the only way I can get him the attention he needs.   He is adamant about not wanting medical interventions, however he still needs to be seen ...

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Top stories in health and medicine, September 3, 2014From MedPage Today:

  1. Low Carb Beats Low Fat for Weight Loss, CV Risk. For weight loss and for reducing cardiovascular risk, cutting down on carbs was a more effective strategy than limiting fat intake in a randomized trial.
  2. States To Help Pay Obamacare Tax on Insurers. When Congress passed the Affordable Care ...

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I never understood the loss of empathy during medical training. Until now. It was 4:30 a.m., and I was on the side of the road, drenched in sweat and tears. I had finally slowed my breathing to normal. I was going to be late for rounds. No time to obsess over possible questions. No time to memorize lab values, or practice regurgitating them. I thought of home. My family and friend, who I hadn’t ...

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As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, "Where to teach?" I do not mean to imply a geographic sense to the word "where" (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a "level." What level do I teach our residents ...

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