Ferguson: What should physicians do? There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest 
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While millions of Americans are re-enrolling in Obamacare, signing up for health insurance for the first time, or double-checking the plans their employer offers, many will undoubtedly ask what’s affordable for them. Good luck defining affordability. Like beauty, it’s in the eye of the beholder. To better understand what affordability in health care means from the vantage point of the ‘kitchen table,’ the National Quality Forum, with support from the Robert Wood ...

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

  1. Duplication Error May Make Giants. A duplication in a short stretch of the X chromosome may be responsible for a specific type of gigantism seen in children.
  2. Lab Work Moves More Quickly to Clinical Setting. A second investigational drug in the isocitrate dehydrogenase (IDH) inhibitor class has demonstrated activity ...

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The food stamp program helps over 40 million Americans pay for groceries. Unlike other forms of economic assistance, this program, called SNAP (the Supplemental Nutrition Assistance Program), only pays for food, thereby constraining how recipients make use of the aid. But are food stamps constrained enough? SNAP recipients experience higher rates of obesity and diabetes than the general  population.  Experts estimate that SNAP recipients consume almost twice as many calories ...

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In a controversial study, Tufts University’s Center for the Study of Drug Development estimates that the cost to bring a new drug to market exceeds nearly 2.6 billion dollars.  The study, which was 40 percent funded by industry has been criticized for over estimating these costs in favor of industry and misrepresenting some cost estimates.  While we will not know fully the extent of the methodology of the study ...

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The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut's Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its ...

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Recently, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year history. In doing so, CMS followed the lead of the U.S. Preventive Services Task Force, which had previously given a "B" grade recommendation for screening in a similar population through age 80 ...

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Get help: Most physicians are not good at business We’ve all heard or used the phrase, "Leave it to the professionals." It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car ...

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A walk in Central Park: Contemplating physician burnout There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help. That immediate ...

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

  1. Men on ADT Skipping Out on Bisphosphonates. Few men in Canada receiving androgen deprivation therapy (ADT) for prostate cancer have simultaneous bisphosphonate treatment to prevent fractures.
  2. What Every ED Should Have. The emergency department (ED) is one of the highest risk areas of any institution. Both the fast-paced environment ...

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A few months ago I assessed a patient with dementia.  I dutifully ordered the appropriate blood testing and MRI.  As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment.  The best way to differentiate these two syndromes is neuropsychological testing.  I decided to send my patient to a colleague ...

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They didnt do anything! The inverted homeopathy of the ER. How often do we have this interaction: "My wife was here yesterday for belly pain.  That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!" (Frequently spoken by spouse.) Records are reviewed.  Treatment:  Included numerous doses of morphine and phenergan, as well as fluids and Zofran.  Frequent warm blankets were ...

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After residency: I’m scared to practice outpatient medicine As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this? Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient ...

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My husband and I both like to run.  I run about 3 miles once or twice a week -- if the weather’s not too bad, and if I don’t have something else going on.  Keith, on the other hand, runs half marathons.  He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week.  He runs in the heat, rain ...

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Can serendipity be engineered? You know the story. It goes something like this: On an ordinary September morning in 1928, Alexander Fleming, a Scottish bacteriologist working at St. Mary’s Hospital in London, came back from vacation to find that one of his Petri dishes containing Staphylococcus aureus growing in culture had been contaminated by greenish mold. Instead of throwing a fit, Fleming grew curious over this finding. After ...

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In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately ...

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

  1. SIPS: The New Kid on the Bariatric Block. Duodenal switch is an effective procedure for weight loss, but it currently accounts for less than 5% of all bariatric surgeries due to concerns about technical difficulty, nutritional deficiency, and frequent bowel movements.
  2. Mild Stenosis Linked to Death in Diabetes. Even ...

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Physicians are treating the well, and nurses are treating the sick A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could ...

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As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals. In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have had family slang or nicknames for certain areas of ...

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This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals? Full transcript: The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would ...

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