What health care can learn from Katzs Delicatessen Sometime during the last year of the second millennium, I wrote my last letter in response to the last letter I have ever received. It’s been email ever since. I don’t recall making a conscious decision to stop writing letters. It just happened. I cannot pinpoint the exact date when my work memos, agendas, proposals and various notes, disappeared from my desk ...

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Technology finds its way into our lives not so much in big flashy ways as little ones. Oh, I can do this a little bit faster now, isn't that cool? Wow, isn't this convenient? Oh, isn't this a huge risk to my privacy? Oftentimes, when I start talking about Linux or scripting or the command line or any number of tech subjects that seem increasingly esoteric, I get blank stares from ...

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Let's talk internal medicine maintenance of certification (MOC). I recertified back in 2011, and it was an onerous process capped off with a challenging exam.  Thankfully I passed, and I'm good until 2022. Since then, the American Board of Internal Medicine has made maintenance of certification a more "continuous" process, and is sparking some outcry among physicians.  Wes Fisher has multiple posts on his site ...

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The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status. While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon. Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering ...

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From MedPage Today:

  1. USPSTF Praised for Preeclampsia Guidance. When it comes to whether or not to treat women at high risk for preeclampsia with low-dose aspirin therapy, the U.S. Preventive Services Task Force (USPSTF) guidelines are spot on.
  2. Early Signs of Stroke Missed in Many Cases. Many strokes may be missed in emergency departments (EDs) in the days before the problems become obvious.

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Sometimes it seems that life is unfair and the odds are stacked incredibly against us.  More than 1 in 3 persons will get cancer.  The chance of survival if you get lung, pancreatic or brain tumors is pathetically small.  The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers. However, there are remarkable stories of hope.  Here ...

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A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions. In short, patients were less likely to fill a prescription if the treatment was expensive, but certain ...

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Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave.  This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad.  The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in ...

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The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very ...

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One of the hardest things about being a surgeon is the inevitability of complications. It's true for any doctor; but with surgery, it's as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big ...

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What would you think if I told you that Medicare will require laboratories to disclose to CMS payment rates from private insurers? Or that they will identify physicians who order a high volume of CT tests and require them to pre-authorize those tests in 2020?  How about that CMS will begin its own analysis of the time and cost of providing services in order to determine RVUs, a job currently ...

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From MedPage Today:

  1. Diet Rich in Beans, Lentils, Peas Lowers LDL. People who consumed a serving a day of dietary "pulses" -- such as beans, chickpeas, lentils and peas -- significantly reduced their low-density lipoprotein (LDL) cholesterol.
  2. Dad's Extra Pounds Tied to Kid's Risk for Autism Disorders. Paternal obesity was strongly associated with increased risk for several autism spectrum disorders in children.

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I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to Google me and have my blog come up on the first page of hits. Now that I've been retired for over a year, I still have not ...

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You know those little packets of paper, folded over eight times, written in type that can’t possibly be seen? You’ve seen them glommed onto the side of stock bottles of medications, or shoved into the paper box alongside a tube of prescription ointment. That unreadable thing is the official “product information,” often called the “label,” required for every FDA-approved medication. It contains all sorts of information, including lists of 
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Translational research is a catchphrase in biomedical circles these days. But if you’re confused about what the term really means, you’re not alone. It was 35 years ago when I first heard the term “translation” in a scientific context. It was about enabling basic research undertaken by the National Institutes of Health (NIH) to find its way into treatments for patients. Though that sounds pretty straightforward, I still have to explain ...

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I felt a little sad when I read a piece in the New England Journal of Medicine about the introduction of point-of-care ultrasound in medical education. In it, two cardiologists from the Brigham and Women’s Hospital review the promise and some of the challenges of incorporating hand held ultrasonography into medical education and, more broadly, into medical practice. For those of you unfamiliar with the technology, this is not ...

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Can narrative medicine inform quality of care? As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough -- not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our ...

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Our privacy is eroding. Some of this erosion is our own fault -- we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication -- electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much -- if Target knows that I buy a lot of Cheerios, I’m ...

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From MedPage Today:

  1. E-Cig Poisoning on the Rise. Poisonings from electronic cigarettes and their nicotine liquid have increased dramatically.
  2. West Nile Monitoring Needs Upgrade. The system used to monitor West Nile and other arboviruses in the U.S. is in such disarray that gaps might compromise the ability to detect and respond to outbreaks.
  3. Lassa Fever Reported in U.S. A man is in ...

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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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