After residency: I’m scared to practice outpatient medicine As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this? Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient ...

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My husband and I both like to run.  I run about 3 miles once or twice a week -- if the weather’s not too bad, and if I don’t have something else going on.  Keith, on the other hand, runs half marathons.  He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week.  He runs in the heat, rain ...

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Can serendipity be engineered? You know the story. It goes something like this: On an ordinary September morning in 1928, Alexander Fleming, a Scottish bacteriologist working at St. Mary’s Hospital in London, came back from vacation to find that one of his Petri dishes containing Staphylococcus aureus growing in culture had been contaminated by greenish mold. Instead of throwing a fit, Fleming grew curious over this finding. After ...

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In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately ...

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

  1. SIPS: The New Kid on the Bariatric Block. Duodenal switch is an effective procedure for weight loss, but it currently accounts for less than 5% of all bariatric surgeries due to concerns about technical difficulty, nutritional deficiency, and frequent bowel movements.
  2. Mild Stenosis Linked to Death in Diabetes. Even ...

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Physicians are treating the well, and nurses are treating the sick A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could ...

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As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals. In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have had family slang or nicknames for certain areas of ...

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This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals? Full transcript: The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would ...

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Two patient result letters: Which one did this physician send? Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada. Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. ...

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“There was one time when I wasn’t here for seven months in a row,” ”Pam” told me. I sat with Pam in her third floor hospital room -- the floor on which she always stays when admitted to the inpatient medicine service -- as nurses, doctors, and janitors poked their heads in the door to say friendly hellos and “Nice to see you again, Pam!” A dining facility staff member entered ...

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One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients. I began to understand this paradox clearly when I listened to my friend’s anguish. She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town ...

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Top stories in health and medicine, December 2, 2014From MedPage Today:

  1. Medicare Tightens Non-Emergency Ambulance Use. Seniors living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments.
  2. NSAID Effective for RA Symptoms, Celebrex Easier on Stomach. Pelubiprofen, a non-steroidal anti-inflammatory drug (NSAID) that is related structurally ...

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CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient ...

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Regulations are changing the very heart of medicine You treat a disease: you win, you lose. You treat a person, I guarantee you win - no matter the outcome. - Patch Adams Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. ...

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3 ways to make health IT work better for nurses The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting. The theory behind this push, which is part of the federal government’s meaningful use policy, ...

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Everyone cries when they bury their dead When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to ...

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If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team. I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own. Admittedly, it’s not quite the surgeon general who ...

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Consider the lipstick sign in your next physical exam The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning. Fine motor skills and concentration can be correlated with a positive ...

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Top stories in health and medicine, December 1, 2014From MedPage Today:

  1. CDC: HIV Remains Uncontrolled for Most Patients. Only three Americans in 10 with HIV had the virus under control in a 2011 snapshot of the epidemic, the CDC is reporting.
  2. Atherosclerosis a Signal for Brain Drain? Asymptomatic atherosclerosis could be a warning sign for cognitive impairment risk.

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The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp. As an OB/GYN I want to tell you how bad this actually is. The most ...

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