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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Most mornings, I opt to take the red line commuter train from my apartment in Bethesda, Maryland to my hospital in Washington, DC. Despite the costly two-way fare, it’s a worthwhile journey because it’s a chance to observe the various other commuters making their way to all sorts of destinations. It’s a people watcher’s dream! Some look dressed to impress on Capitol Hill or in corporate offices. Others look as ...

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

  1. Moderate TSH Suppression Best. Moderately suppressing thyroid-stimulating hormone (TSH) after treatment for differentiated thyroid cancer may be the best strategy.
  2. ACA's Role in Election Varies by Location. As the country prepares for elections next week, the Affordable Care Act's (ACA) role in statewide and Congressional elections has varied.

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Whatever our individual belief systems, here is a cause that can unite us. Whatever our party affiliations, this can cause us to "reach across the aisle." Whether or not we are religious, or believe in this life only or the next, this is a cause we can agree on, here and now. Conservative or liberal, right or left, theist or atheist, libertarian or green, male, female, gay, straight, we must ...

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The Affordable Care Act. Obamacare. No matter what you call it, the law has two main goals: Insure more (all?) Americans, and in doing so, lower the aggregate costs of health care in the U.S. After year one of the Act’s main rollout, there is no doubt about the first goal: Millions more Americans now have health insurance. Many have purchased it on the exchanges, whether they are state-run (best example might ...

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After a prostate cancer diagnosis: The urgency to treat Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something ...

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If I had to choose one theme that has stood out in the first weeks of medical school, it would be this: questions, questions, and more questions. In the first class on our first day of medical school, our professor set the tone by laying down the requirement that we ask a minimum of ten questions before the lecture was over. Based on my experience in large undergraduate lectures, where ...

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Ebola is a scary topic; there’s no doubt about that. With the onslaught of media coverage that has no end in sight, it’s likely that older children have already heard of the Ebola outbreak or will hear about it in the near future. The question is, what can we do to help our kids work through the confusing and frightening messages they see on television? Here are some suggestions to help ...

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Dear ACO General Hospital: Thanks for contacting me about my most recent blog post.  I'm sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information. I know it's kind of embarrassing to have that kind of thing made public, and I am overall ...

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Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists. From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s ...

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Why is medical IT so bad? A 57-year-old doctor I know is retiring to teach at a local junior college.  He is respected, enjoys practicing medicine and is beloved by his patients; therefore, I was surprised. While he is frustrated by the complexity of health insurance, tired by the long hours and angered by defensive medicine, the final straw is that he can not stand the world ...

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During my first year of medical school, in the last year of my father’s life, his oncologist had a difficult discussion with him and my mother- the decision to become do-not-resuscitate (DNR). I remember my mother was taken aback, my father was relieved and I was deeply saddened.  However, when I got the call that my father may not make it out of the hospital this last time, I was ...

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7 ways to help your caregiver My illness has been as hard on my caregiver-husband as it’s been on me. I know how fortunate I am that he’s stuck around and that he never complains about the extra burdens he’s had to take on. My heart goes out to those of you who don’t have someone to care for you in this way. This piece covers several ways ...

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When an unconscious person is first brought to the emergency room, there may be little indication if the individual has diabetes or a thyroid condition. Since millions of people have common hormone health conditions like these, emergency room clinicians and other acute care providers need to watch for cases where an endocrine disorder is causing or contributing to a medical emergency. More than 29 million people in the United States have diabetes, ...

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Whats the right way to think about Ebola? Ebola has riveted our attention: It’s a deadly disease with no known cure, and as is true of most infectious diseases, it’s easy to imagine how it could become a global pandemic and threaten us directly. For what it’s worth, though, here is what the federal Centers for Disease Control and Prevention tells us about Ebola: 1. The Ebola virus is not spread through:

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 ...

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Medical students are brilliantly frugal. And it’s no surprise -- according to the AAMC, the average U.S. medical student incurs $170,000 of debt from medical education. We are a resourceful, smart, and cost-conscious group -- so why is the medical school curriculum practically silent on the cost of medicine? During medical school, we are taught to be excellent diagnosticians. The third and fourth years of training provide 60 to 80 hours a week of ...

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