In September, Doximity, a closed online community of over 300,000 physicians, released its ratings of residency programs in nearly every specialty. Many, including me, took issue with the methodology. Emergency medicine societies met with Doximity's co-founder over the issue and echoed some of the comments I had made about the lack of objectivity and emphasis on reputation. I wonder if it is even possible to develop a set of valid ...

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No CT scans for old smokers? "Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a 'check-up,' or 'screening,' when their computerized records show they are 'due.' Non-attendance is known as 'non-compliance,' indicating an element of recklessness and irresponsibility." - Petr ...

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MRI: Myth or reality? A radiologist answers your questions. From seeing elegant pictures of our brain and spine, to definitely characterizing masses in the liver and guiding management of orthopedic issues, MRI has an established role in the delivery of optimal care. MRI is an amazing tool that allows us to see inside our bodies and helps us get answers about a wide variety of medical conditions.  As a radiologist ...

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From a physician: A plea to big medical corporations I thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen. Then I became employed by ...

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We all want to practice evidence-based medicine.  Yet that phrase is so overused that one must always question the true meaning underlying the use of the phrase. The first assumption that many make is that evidence is a solid structure without nuance.  Yet we can have different experts look at the same evidence and develop different conclusions!  Why else would we have competing guidelines. Consider this quote from Nietzsche: "There are no facts, ...

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One of the hardest parts about medical school for me has been the constant pursuit of approval. Having a pass/fail system during pre-clinical years helped ease things some, but there remains a personal desire to prove myself. In front of attendings, all I can focus on is performing my physical exam just right, presenting in the perfect manner, and nailing the assessment and plan. Unfortunately, my strong desire to look ...

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A while back I was sitting in a Toronto coffee bar and, as I often do in another country, I began chatting with people about their health care system. One employee taking people's orders was about to go off duty and sat down to visit. "I'm tired of hearing you Americans talk about rationing in Canada," he said. "Let me tell you how many MRIs I had when I was ...

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Burnout in medicine: Look beyond your comfort zone For those of you who have been riding along with me on my journey for the past few years , you know that it has been one heck of a ride. What started out as a little blog to encourage other doctors who were struggling with burnout has exploded. In a good way. My blog came about because I was looking for a ...

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We’re ready to work on cost savings, just not for patients. There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care.  One of the paradigm shifts is for hospitals to embrace the strategy of cost reduction as opposed to the traditional focus on top-line revenue.  In a system that focuses on value rather than volume, increasing the amount of hospital resources a patient consumes ...

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“If I get a call about smallpox from the ER I’m not coming in,” an infectious disease doctor said to a colleague in the hospital where I was working.  It was the early days of 9/11 and anything seemed possible. “Are you all OK with providing care for Ebola patients?” our section chief asked.  Our ICU is the designated unit to care for all adult patients suspected of having Ebola in our system.  We ...

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According to IBM, there are 2.5 exabytes of data created every day, and most of it is unstructured. Imagine receiving all the words ever spoken by human beings on your doorstep each and every day. Now, imagine consuming that, making sense of it and trying to keep up with the ever-accelerating pace of data creation each day. As a physician, I experienced firsthand the angst that comes with trying to keep up ...

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The largest challenge facing the infectious disease community in the 21st century is the increasing number of resistant organisms found in various disease processes.  The reason is much more complex than the over prescribing of oral antibiotics for sore throats.  This is not to say that good antibiotic stewardship is an important concept because it is but it must be recognized that the medical challenges of the human population today is ...

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Physician ratings reward doctors in narrow practice Admit it, we all do it. All physicians check their quality ratings on the various online sites. If the site allows comment, we read the comments. If we get a bad rating, we try to figure out who was the patient. Isn't that the chronic back pain patient who was addicted to painkillers and got mad at me because I wouldn't renew ...

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After the latest school shooting, social media accounts should be monitored In the wake of the latest school shooting in the state of Washington, much attention has been paid to the shooter’s (Jaylen Fryberg’s) Twitter account. In fact, after a school shooting, social media sites are typically the first place that people go to learn about the assailant. While this is understandable, one has to wonder if any of these school shootings ...

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I have been a victim of diagnostic overshadowing by a primary care physician.  I’ve been dealing with major depressive disorder, recurrent, severe and anorexia for twenty-five years -- practically my entire adult life.  However, I work full-time and I’m a published writer.  At the time I saw this PCP, I was on hefty doses of Cymbalta (an antidepressant) and Abilify (an antipsychotic which can also be used to boost the effects of an ...

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What I wish I knew: Advice for spouses of doctors and residents Residency life. I don't talk about it much, and that's on purpose. Here's why: My life is wonderful. I really love it. Is it perfect? No. Is anyone's life perfect? Definitely not. I would never wish to portray my life in a negative fashion and certainly not to wish for sympathy. I would talk about it in an informative way, but even ...

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The tragic case of Thomas Eric Duncan represents a failure of communication with consequences that extend well beyond the current Ebola crisis. When Mr. Duncan first presented at Texas Health Presbyterian Hospital in Dallas, his recent travel history from Liberia was reportedly ascertained and entered into the hospital’s electronic health record (EHR) system. Somehow, this critical piece of information never registered with the physician who diagnosed Mr. Duncan, and in ...

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Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies Don't Yield Expected Results, Study Finds.” This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an ...

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One of the most frequent questions gastroenterologists are asked about is diet, health and disease; and some of the questions gastroenterologists are least comfortable answering are about diet, health and disease. This disconnect occurs for several reasons. Although the subject of nutrition is taught in medical school, it usually covers malabsorption of nutrients, vitamins and minerals that have limited relevance to the concerns of most patients. The modern physician does not see ...

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The days of using your insurance to see the family doctor are numbered. As more patients join the practice and I hear each new patient’s story, I become more impressed with the benefits of direct primary care for both the patient and the physician. Recently, a 63-year-old female, who we’ll call Martha, came in for a visit. Martha is an out of work chef who, due to financial hardship, hasn't had health ...

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