One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider.  This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters.  The format is pretty standard no matter what medium is chosen.  You thank the referring doc for the consult request, you give some brief background info about the patient in question, and ...

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"I've been getting winded lately." He's a middle-aged man with diabetes.  This kind of thing is a "red flag" on certain patients.  He's one of those patients. "When does it happen?" I ask. "Just when I do things.  If I rest for a few minutes, I feel better." Now the red flag is waving vigorously.  It sounds like it could be exertional angina.  In a diabetic, the symptoms of ischemia (the heart not getting ...

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In the busy world of hospital medicine, where doctors and nurses find themselves rushed off their feet for most of the day, time to sit down and actually listen to patients is at a premium. Every doctor knows that our primary focus has to be on the most important aspects of the history and clinical examination in order to get to the correct diagnosis and treatment strategy. But at some point ...

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I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see ...

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shutterstock_134837474 I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, ...

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medpagetodayFrom MedPage Today:

  1. MedPage Today at 10: Where We Have Been. Sometimes things go so right, that you get nervous. Really nervous. That's pretty much what happened when MedPage Today launched 10 years ago.
  2. Sepsis Readmissions May Be Correctable. It might be possible to prevent many of the hospital readmissions that occur ...

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Recently, I had the honor and pleasure of introducing my book, Women and Cardiovascular Disease, in London. During the event, I was able to meet with many of my European colleagues from both the media as well as the health care space. I spoke with countless bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women. We identified many ways ...

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For 25 years, I have taught medical students how to give bad news.  Step one: Be prepared.  Step two: Find a safe, personal, quiet environment.  Step three, and this is most important: Before you speak, ask.  What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind.   So, therefore, you might ask, if I have such wisdom and experience in this critical area ...

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I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I ...

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asco-logoEvery so often I see a patient who views cancer as a constant threat to be handled. The cancer becomes so significant that she feels she can never let her guard down. I always worry about this -- partly because that singular focus on fighting cancer can sometimes detract one from other aspects of life, and those facets that give ...

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At the end of one of my earlier rotations where I first worked with a team consisting of residents and an attending physician, I sat down with the senior resident for feedback. Much of our final grade for each rotation in medical school comes from a subjective assessment of our abilities, ranging from clinical competence to professionalism. She told me I had done a good job with taking ownership of my ...

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It’s 2015, and we’re talking about measles. Not Enterovirus. Not Ebola. Not RSV. Not influenza. Instead, we’re talking about a historical virus that was declared eradicated from the United States in 2000. Most pediatricians who began practicing within the last 15 years have never even seen the disease. Measles starts as a high fever followed by a cough, runny nose (coryza), red and watery eyes (conjunctivitis), and tiny white spots inside the mouth ...

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medpagetodayFrom MedPage Today:

  1. Surgery Fails to Show Superiority in Shoulder Fractures. The trend of increased surgery for patients with displaced fractures of the proximal humerus may be inappropriate.
  2. Restricting Fructose Cuts Liver Fat in Kids. In just 10 days, restricting the amount of fructose children consumed through sugary drinks and juices resulted ...

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As a physician, you have endured many years of schooling, and you have received many A’s on your report cards. You have passed exams with flying colors, and you have pleased your higher-ups in the food chain. You have come so far, and you now find yourself in a rarefied position that most people only dream about. So what’s standing between you and your thriving life? Clearly you’re smart ...

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When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that ...

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Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively ...

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shutterstock_131910137 American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time. In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is ...

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Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient ...

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The ink hadn't yet dried on the report of the 2015 Dietary Guidelines Advisory Committee before the assaults began. I guess in this day and age, that's not much of a big, fat surprise. Despite all the over-heated rhetoric I've seen about not trusting this report because the "government" can't be trusted, this report is not from the government. While we may, indeed, need to worry about what the political authorities ...

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medpagetodayFrom MedPage Today:

  1. Kid's Asthma Not Linked to Maternal SSRIs in Pregnancy. Children whose depressed mothers took newer antidepressants while pregnant were not at increased risk of childhood asthma.
  2. Menopausal HT Not Tied to Greater Death Risk. Hormone therapy in postmenopausal women was not linked to a significant effect on all-cause mortality, ...

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