When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that ...

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Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively ...

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shutterstock_131910137 American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time. In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is ...

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Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient ...

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The ink hadn't yet dried on the report of the 2015 Dietary Guidelines Advisory Committee before the assaults began. I guess in this day and age, that's not much of a big, fat surprise. Despite all the over-heated rhetoric I've seen about not trusting this report because the "government" can't be trusted, this report is not from the government. While we may, indeed, need to worry about what the political authorities ...

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medpagetodayFrom MedPage Today:

  1. Kid's Asthma Not Linked to Maternal SSRIs in Pregnancy. Children whose depressed mothers took newer antidepressants while pregnant were not at increased risk of childhood asthma.
  2. Menopausal HT Not Tied to Greater Death Risk. Hormone therapy in postmenopausal women was not linked to a significant effect on all-cause mortality, ...

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One of the cornerstones of the practice of medicine is finding imperfection in things. When the doctor encounters the patient, the latter expects the former to find out what is “wrong.” In fact, I often see a patient and find nothing wrong, and when I voice this out loud the parents often ask, “Are you sure?” I completed medical school over 7 and a half years ago. During that time I’ve ...

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We want to make sure that we stop it before it starts. It’s so much easier to prevent bad medicine than it is to stop it after it’s started. – Arkansas Rep. Julie Mayberry (R-East End) speaking on Arkansas Public Radio about SB-53, a bill that restricts medical abortions by preventing them via telemedicine -- an unfortunate development for the 78 percent of Arkansas women who don’t live near ...

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A 75-year-old woman with progressive constipation. An 82-year-old man with unexplained anemia. A 39-year-old mother of two with intermittent blood in her stool. These are three of my patients. And sadly, they are three of nearly 150,000 Americans diagnosed with colorectal cancer every year. March is National Colorectal Cancer Awareness Month for good reason. In the United States, colorectal cancer is the third most commonly diagnosed cancer. It is also the ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The health care landscape is changing, and now more than ever we as physicians should be focused on quality of care and ensuring the safety of our patients. Anesthesiology was the first medical specialty to champion patient safety as a specific focus. Over the past century, physician ...

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I remember one day a few years ago when I was talking with one of my friends about the challenges of being a doctor after a tough day at work. I had seen a large number of patients within the span of a few hours, and in addition to many of them being sick, I dealt with family members who had so many questions and who wanted to provide me ...

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shutterstock_224345509 I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience. One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I ...

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GVE8468-640x424 Standing on the edge of his hotel balcony, a doctor describes the rolling hills. He tells me, “It’s a beautiful place to die.” Ten minutes later, he agrees not to injure himself -- for now. I’m not running a physician suicide hotline. But doctors keep calling me. It’s midnight, and I’m speaking to a psychiatry intern. Bullied by residents and her attending, she ...

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medpagetodayFrom MedPage Today:

  1. Gout and CVD: Combo Is More Likely in Women. Patients with gout are at significantly high risk for developing cardiovascular disease, with the likelihood being greater for women.
  2. Better Metabolic Profile for Teenagers Who Eat Nuts. Teenagers who ate the equivalent of a small handful of nuts three times ...

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In the last year and a half, I've been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I'm not actually vacationing. Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how ...

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“The patient’s pain is still 9/10, doctor. We’ve already given morphine IV and then changed to Dilaudid IV and then we increased the dose of Dilaudid. Can we give it every two hours instead of every three hours?” the nurse asks me over the telephone. I sigh heavily into the receiver, unsure what to do, feeling more like a drug dealer than a doctor. The patient is on horse-sized doses ...

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In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In both venues, the call to “population health” elicited sighs of exasperation. It’s just another checkbox we are being asked to click off. How can we be assessed on that as ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications. On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. ...

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There have been huge advances in patient safety, but that doesn’t mean there is no risk when it comes to having surgery and anesthesia. Each year there are more than 100 million operations and procedures performed with anesthesia.  Doctors who specialize in anesthesia -- we’re known as physician anesthesiologists -- play a critical role in keeping patients safe and comfortable before, during, and after surgery. Before surgery, a physician anesthesiologist checks ...

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Dr. Wes has written passionately against MOC: ABIM Pleads for Mercy.

But perhaps we should ask first: Why MOC at all? Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM’s website, might MOC have really been created because the ABIM’s consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% ...

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