Few would argue that today digital technology represents a critical part of marketing in any business sector.  Though all health care stakeholders are usually late to the technology table, market and customer pressure are rapidly accelerating this adoption. It needs to be emphasized that technologies are not solutions. They must be incorporated into human workflow processes. To do so in health care, culture must change, specifically with regards to patient participation, ...

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The first Ebola patient has been diagnosed in the U.S. This news is likely making many of my regular readers wonder, “Should I freak out?” This is a reasonable question, and I will attempt to answer it. But first, let’s go over how this nasty microbe spreads. Ebola is caused by a virus that is transmitted through contact with the bodily fluids of someone who is sick. It is not airborne; ...

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This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school. A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut ...

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Motivate patients to exercise more and eat less “Plank? Is that a board?” asked my patient. I had been encouraging her to start doing exercises to strengthen her core in order to stabilize and support her back. My hope was that over time, these exercises would lessen the need for pain medicine. There are times for words and there are times for action. So I got down on the ...

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I received my new thinner bigger iPhone.  Within a few days, news reports highlighted how new iPhone 6 owners accidentally bent the latest Apple iteration of the modern smartphone. A blogger bent an iPhone 6 Plus with his bare hands. This story, the subsequent fallout, and response has learnings for doctors and health care on the challenges facing the vaccination “debate.” The best launch in iPhone history with roughly 10 million smartphones shipped ...

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A medical student recently asked my advice on her decision to pursue a career in dermatology. It was about 25 years ago when my own parents encouraged me to pursue this specialty. What was their deal? Perhaps, they anticipated future developments in the field and were hoping for free Botox treatments? As readers know, I rejected the rarefied world of pustules and itchy skin rashes for the glamor of hemorrhoids, ...

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My student’s voice trembled as she answered my question.  “How do you think you’ve done so far?” I’d asked her.  We’d been together on the general medicine inpatient ward for two weeks -- the midpoint of the rotation -- and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance herself. “OK, I guess,” she replied. I waited to ...

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There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating ...

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The Ebola outbreak: Dont blame the nurse There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in Liberia. Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. ...

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I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant. The telephone rang with the caller ID identifying a call on my office work line. “Hello this is the emergency department, please hold on for Dr. S.” ...

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Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence. As is ...

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Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits. Unfortunately, too many Americans lack easy access to primary care.  Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. ...

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The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications ...

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How to improve doctor administrator relations A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks ...

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Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola. Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also 
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The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public -- and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed. As a result, the responsibility ...

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Dr. Danielle Ofri has an important piece in the New York Times: "The Physical Exam as Refuge." As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition? While I did outpatient medicine for ...

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Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks. Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ ...

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There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald's that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances.  Or at least that is how the proponents of algorithmic medicine see it. In addition, electronic health record systems create uniformity by enforcing ...

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