After 12 years of blogging, I wonder if I should have titled my blog “unintended consequences.” So many rants focus on the unintended consequences that follow from health care policies. The aphorism (falsely attributed to Samuel Johnson) states, “The road to hell is paved with good intentions.” Too often our policy makers, be they bureaucrats in government, insurance company managers or guideline creators, think like a chess beginner. They see the ...

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There are doctors that patients see. And there are the doctors that patients almost never see. Patients see me, an obstetrician, at prenatal visits, in the ultrasound unit, or on the labor floor. But they don’t see all the wise radiologists reviewing their imaging studies, or the educated pathologist assessing whether their biopsy is cancerous. Some of the most important doctors that our patients don’t see are the ones in the ...

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Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me. I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn't get written for her care by the admitting physician. ...

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She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious.  She tells me about her two grandchildren, and how she just visited them in Michigan.  She came to the hospital, straight from the airport.  She’s worried. She’s worried because her shortness of breath hasn’t gone away for over a month now.  She has had breast cancer, and opted for a more conservative approach: a ...

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As Americans, we love to associate with groups. More than that -- we love to plant ourselves in a group, stand firmly in our decision, and then adamantly refuse to budge or to see the other party’s perspective. Pro-life. Pro-choice. Democrat. Republican. Pro-Obamacare. Anti-Obamacare. I suppose for all of us, myself included, it is easy to identify with our group of choice when we are sitting at home watching or reading our ...

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The doctor who has to do the laundryThe doctor who has to do the laundry An excerpt from So Long, Marcus Welby, M.D.: How Today's Health Care Is Suffocating Independent Physicians - and How Some Changed to Thrive. Ripley Hollister has been president of his county's medical society in Colorado Springs, Colo., and a director of the Colorado Medical Society. He has been a unit commander ...

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Top stories in health and medicine, August 12, 2014From MedPage Today:

  1. Low Obesity Risk Score Can Still Equal Major Health Problems. Young adults who scored slightly higher on an obesity risk assessment scale still had significantly worse dietary habits than those who were at lower risk.
  2. Feds' $10 Billion Search For Healthcare's Next Big Ideas. The Affordable Care Act was ...

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Medical lessons from Robin Williams Dear Robin, You were such an inspiration.  You showed us courage in the face of adversity, making us laugh while your own soul was broken. Even now, at the time of your death, we find ourselves in a recently forgotten place where all people -- regardless of faith, color, or country of origin -- stand united, sending out love to you and your family. You ...

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To be quite blunt about it, Ebola is a very scary disease. Among those infected, the mortality rate is, as is perhaps now widely known, an appallingly high 90%. That would seem a very good reason to keep our borders closed to this scourge -- and the consequences to the poor souls who already have it be damned. That, apparently, was just the kind of thinking behind at least 
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7 ways patients can help reduce medication errors I just got off the phone with a very upset patient who had just discovered that her pharmacy had been giving her the wrong medication for the past 5 months, substituting a similarly spelled antibiotic for her rheumatoid arthritis med. She was tipped off when she realized how bad she had been feeling of late and decided to check the expiration ...

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After more than 40 attempts to pass legislation calling for repeal or significant changes to the health law, opponents of the Affordable Care Act have moved their focus from the House floor to the courthouse. Currently at least four lawsuits are working their way through state and district court -- and one case awaits a nod from the Supreme Court -- that would make it illegal for the federal government ...

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Two years ago, I received my first employment contract. Not long after Match Day, I did what 115,000 physicians in training did that year and will do again this year: I signed the contract promptly and returned it. I tried to read the contract carefully, but it didn’t really matter. Unless you no longer want to be a physician, there is no other choice but to sign. Today, as president of my ...

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Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions.  In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting ...

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Nearly every day we read headlines about the serious prescription drug problem in America.  Increasing heroin addictions and deaths from illicit drug use are taking a severe toll on far too many families and communities. While we must feel enormous sadness for the families experiencing these tragedies, we must not overlook the other major health crisis that is often associated with the opioid abuse problem: chronic pain. The chronic pain crisis ...

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Top stories in health and medicine, August 11, 2014From MedPage Today:

  1. Psoriasis Ups Risk of Cancer, Serious Infection. Rates of malignancy among patients with psoriasis outpaced national averages, irrespective of therapy in most cases.
  2. Psoriasis: Screen for Fatty Liver Before MTX? What began as a case of chronic plaque psoriasis has evolved into consideration of routine testing for nonalcoholic steatohepatitis ...

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I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient.  That seemed self evident and logical.  "Do no harm" was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make "the right" decision for them -- not necessarily including them in the conversation or ...

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Ebola is a hemorrhagic fever that causes death by what seems like a virally induced stigmata. That statement could be even shorter. With a fatality rate that can reach 80 to 90% we could just say that Ebola is death. The World Health Organization (WHO) says this most recent outbreak is “moving faster than our efforts to control it” and the CDC is calling this “The biggest and most complex ...

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In a New York Times column, Thomas Friedman recent wrote about what Google values and seeks in its new employees. Striking to me was the fact that overall intelligence ranks lower on their values totem pole than several traditionally more important attributes. So, what can medicine learn from Google and how can we apply it to our admissions process? Here are five key points from the article, adapted to our admissions ...

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A primer on the anesthesia care team modelA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist.  Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician.  Once we get into the discussion, patients are also surprised to learn that ...

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10 potential benefits of robot caregivers My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy. I have to admit that my own first reaction to the topic was captured in the Times' letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … ...

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