When school boards fancy themselves health care providers I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease. On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath ...

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Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates that benefits ...

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There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids. Over 44,000,000 American children (more ...

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There is a tremendous amount of handwringing among students, workforce researchers, and medical school deans about the record amount of debt that medical students incur -- more than $175,000, according to the Association of American Medical Colleges. This has unintended consequences, including student selection of more lucrative specialties and placing medical education beyond the reach of low-income and minority students. The average household income for a matriculating medical student is ...

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Earlier this year, I started teaching a course to first year pediatric residents at Stanford. In it, I challenge the trainees to identify the structural contexts in which patients and families make choices that may impact their health and well-being. Termed structural competency, the goal is to enable young physicians to understand and confront stigma and inequality as key determinants of health. We talk about ...

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The Ellen DeGeneres Show has repeatedly put out a call for viewers to send in their funny sunburn pictures and stories. The following was posted on the website:

Summer is here and everyone is hitting the beach or pool. Just don't forget the sunscreen! If you did, and you have the bad sunburn to prove it, we want to see the funny photos. Be sure to tell us the story behind ...

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Conflicting state versus federal incentives confuse doctors I get paid by Medicaid to see patients. How much? Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 ...

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According to the recent Wall Street Journal article patients are encouraged to engage in care, keep track of their medical data, seek preventive care, and to manage their conditions. Studies show that if patients are actively involved in care and partner with providers, that they experience better health outcomes and lower costs. But for patients to be active participants in care they must acquire knowledge about their diagnoses and treatment plans, ...

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On a cold, blustery Cleveland day when I was a resident, a forty-year-old man walked into our infectious disease clinic at the Cleveland Clinic. The patient was undergoing routine visits in preparation for a kidney transplant. This poor man had been hospitalized six months earlier at another hospital where he caught a terrible infection and was readmitted in septic shock and multi-organ failure. Luckily he survived, but in the process ...

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There’s no good age to die. Way too many of the patients I’ve seen over the past two years are harrowingly close to my own age. I think it’s less startling to hear that an older person has cancer than when a young person is diagnosed, but I have yet to identify the age when this transition happens. Maybe it’s an unspoken understanding that older people die and younger people shouldn’t, but ...

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In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education.  "At its essence," explained Zakaria, "a liberal education is an education to free the mind from dogma, from controls, from constraints.  It is an exercise in freedom."  His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that ...

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An intriguing article was recently published in the Proceedings of the National Academy of Sciences -- one of the most prestigious (more on “prestige” later) journals around -- with the provocative title, “Rescuing U.S. Biomedical Research from Its Systemic Flaws.” That this was written by some of our country’s most well-respected scientists provides credibility to this challenging and thought-provoking critique. The piece ...

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Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order. It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t ...

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Reduce health costs? Stop focusing on physician salaries.My latest USA Today column is now up: Doctors are not overpaid. I explain why focusing on physician salaries won't do much to dent health costs. Also, as I wrote in a prior blog post, "Pay me like a French doctor. You know you want to," any salary comparison with other countries also needs to consider their costs of medical education ...

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

  1. Proposal To Add 'Copper' Plans to Marketplace Raises Concerns. If you offer it, will they come? Insurers and some U.S. senators have proposed offering cheaper, skimpier "copper" plans on the health insurance marketplaces to encourage uninsured stragglers to buy.
  2. Childhood Malnutrition May Raise HTN Risk. Young adults who survived ...

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Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens. They come in all sorts of shapes and colors:

  • The sixty-year-old man diagnosed with a strained lower back muscle who comes back with a ruptured abdominal aortic aneurysm.
  • The fifty-four-year-old Hispanic female with generalized malaise who goes into cardiac arrest from a missed myocardial infarction.
  • The two-year-old with ...

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Over the past few months, more attention has been paid to the prescription drug epidemic, with increasing rates of accidental deaths noted across the country. Legislatures in different states are currently considering laws to provide first responders access to reversal agents, such as naloxone, to treat people found on the scene who have likely overdosed on these medications. With increasing media coverage, the public is becoming more aware about the ...

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When the Joint Commission is at the hospital, leave Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before. If you’re a patient who walks into a hospital for an elective procedure of any kind -- surgery, or a diagnostic test -- and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left. Why? ...

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Should doctors be paid overtime for taking call? Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call. Granted. However, these awful events are part of ...

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