Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing "report cards" that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery. Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals. Has ...

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On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender. Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago. He's a 55-year-old African-American man with hypertension, elevated cholesterol, and a history ...

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I’m not a doctor.  And sure, you know your patients better than I do. But, I have been a patient and as a patient, I know how we think. As someone who works in health IT helping to create software to better connect patients and providers, I like to think I have a hypersensitive pulse on what’s going on. I know that as patients, sometimes we get frustrated trying to solve ...

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Is nerve block anesthesia better for surgery?A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More needles ... who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease your risk ...

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When they’d first entered their medical practice, some of my clients had asked an instructor or mentor to review their prospective employment agreement for them. Although these people may have been excellent physicians or teachers, they weren't acting in the best interests of their charges. When it comes to your livelihood, it's important to have an attorney, especially one who’s experienced in health law and has drafted hundreds of these ...

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As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need -- even for those who ...

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There's been a lot of hype about the "Ban Bossy" campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously "bossy," or at least referred to as such. I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, "You ...

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I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see.  Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk ...

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Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants.  I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice.  When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected. My fear is ...

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I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit.  After a few days, she had been extubated and had acquired a new diagnosis: asthma.  When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of ...

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For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it. Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for increasing asthma symptoms. Her symptoms now require her to use her as-needed albuterol inhaler two to three times per week, and she has been waking up at night at least once a week with asthma symptoms that require her inhaler. She is still able to perform ...

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My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient's health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles ...

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Dont forget those where cancer screening didnt make a differenceI had the opportunity recently to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called "80 by 2018" designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence ...

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She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up. I sighed. "We've done the work-up and know this is not your heart. I don't think there are a lot more tests that can be run." I studied her expression, trying to discern what she wanted to hear from me. I've come ...

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Headlines soared recently with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years. “Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr. Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: ...

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Next in a series. Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the ...

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"I feel bad ..." Amy whispered, then paused. I'm a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I'd been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion. I'm a fan of Planned Parenthood's work providing high quality, affordable contraceptive and gynecological care. In ...

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From MedPage Today:

  1. White Boys More Likely to Be Color Blind. Color blindness is not colorblind, as it appears to afflict Caucasian boys at three times the rate of African-American boys.
  2. Boston Hospital Tackles Problem of Readmissions. Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates ...

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Most humans have spent most of human history nearly starving to death. So it’s no surprise that we spend a lot of time thinking about food. And it’s no surprise that food has acquired cultural, social, and religious significance in almost every society. Because food is so important, and because it’s nearly impossible for us not to ascribe powerful effects to anything important to us, every society imbues special health ...

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