“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.” My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment. The patient had been admitted about 11 days back ...

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My oldest son is almost a second grader. He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test. The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the exit level test to graduate high school. There’s good ...

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shutterstock_138885635 I am presenting my startup costs here, to give some ideas for those providers who are considering starting their own family practice, or for those who say it can’t be done anymore. To become a business, I spent $50 for the state LLC filing, and $12 for business cards. I already had my medical license and DEA from residency, so the only certificate ...

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shutterstock_101193772 I have this life. It's not a cubicle life -- there's a lot of everything in it, and I never really know what the next hour will hold.  Whenever I talk to people about what I do, it's surprising to me that almost no one has any real clue what my life is really about. Here are the impressions that they tell ...

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I recently found something I had lost. Or rather, I found someone I had lost. He was a dear friend from my childhood. We spent days and nights roaming the woods near our homes, catching crawdads and minnows in the creek and turning rocks over to look for banded water snakes. We shot bows and arrows and rode bikes. Standard Appalachian stuff, that. In the winter, we would sled until we ...

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shutterstock_48561808 The medical world has made terrific scientific and technological progress over the last century. Previously incurable diseases can now be treated as day cases, and patients no longer have to accept a paternalistic, one-sided relationship with their doctors. Hospitals too, have a come a long way if you look at pictures of what they used to look like in those old ...

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physician pain scale This cartoon is based on data from the 2015 Medscape Physician Compensation Report. Dermatology is on one end, internal medicine on the other.   The other specialties in between.  Doesn't seem to be a trend between the cognitive and procedural specialities, which is a bit surprising.  You'd think the latter would skew towards the "happiness" side. Do you ...

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051809+Maureen+Dowd+p1 If I’m to take fashion advice from Maureen Dowd’s March 3 column, “Stroke of Fate,” a take-down of emergency medicine disguised as a recovery narrative of her niece, then I should exchange my white coat for grease-stained overalls. In her column, a Harvard neurology professor who specializes in stroke describes the brain as the Rolls-Royce of the human body. When it ...

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An excerpt from So You Got Into Medical School... Now What?: A Guide to Preparing for the Next Four Years. By far one of the most unique experiences first-year medical students can have is working in the gross anatomy lab. From the potent smell of formaldehyde to the chill of ...

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shutterstock_211897159 1. Due to intermittent monitoring versus continuous fetal monitoring which is standard in the hospital, the patient has increased mobility and a wider range of laboring positions/options: sitting, standing, walking, water, birthing balls. The American Congress of Obstetricians and Gynecologists (ACOG) has agreed that there is not a medical benefit to continuous fetal monitoring compared to intermittent monitoring in low-risk women. 2. ...

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The room hung silent when he was done speaking. It was Monday afternoon and I had just barely woken up from sleeping off my overnight shift in the ICU. A few days prior the poet laureate of Rhode Island, Rick Benjamin, asked me to join a poetry seminar he hosts weekly at a local assisted living community. Despite the ache as I lay my head down that morning, I set ...

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shutterstock_178086407 He sat there holding his wife’s hands and hugging her as tightly as he possibly could.  Tears were streaming down her face, and she was vulnerable to the diagnosis I had just bestowed upon her. Cancer, the “C” letter word nobody wanted to hear, suddenly invaded the lives of this newly married couple. Multiple thoughts were running through my mind before bestowing ...

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Often I hear comments from people who have been treated for cancer and other illnesses talking about the things they wish they knew, or things they wish their doctors would have shared with them about their treatments or conditions. I don’t have to remind anyone there is a tremendous amount of anxiety and fear when you are diagnosed with cancer or any other perceived or potentially life-threatening illness. Our health care system has ...

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shutterstock_183558071 Mais où sont les neiges d’antan? But where are the snows of yesteryear? Not many people are experts in medieval French poetry. It’s a tiny little corner of academia, filled with people whose passions and imaginations lie a millennium in the past. And so many of those academics, and I do use that term in the most tweed-wearing, bookish, kindly way possible, have ...

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shutterstock_212693173 I work in a place where nobody calls me by my name. They all address me by a moniker of their choosing that I have asked them not to use.  I have asked them to use my name.  Aside from a few who respect my wish, most of my co-workers just call me by the impersonal-sounding phrase they’ve selected instead.  It creates ...

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A continuing series on physician online reputation.   For more KevinMD minutes, please visit my YouTube channel. Did you know that criticism on physician rating sites can help improve your practice? When patients leave comments on these rating sites, sometimes it's the only way they have a voice. When patients leave my exam room I don't know what they thought about me, the nurses, the medical ...

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shutterstock_166395998 Kaitlyn Elkins was a medical student at the Wake Forest School of Medicine in North Carolina and a member of the class of 2015. She excelled academically, named the valedictorian of her high school class and graduating summa cum laude from Campbell University. She wrote poetry in her free time. She had a cat, lovingly named Gatito. On April 11, 2013, just ...

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shutterstock_176089838 Recent events in Baltimore sparked by the tragic death of Freddie Gray in police custody have thrust our city into the national and international spotlight. As others have observed, the anger, violence and grief that erupted in Baltimore following Gray’s death have roots that run much deeper -- and much wider -- than the highly publicized clashes between law enforcement and minority ...

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We’ve all heard it said that learning medicine is like drinking from a firehose. Yet many students and schools don’t use one of the most effective study techniques available to them. Spaced repetition is a powerful, evidence-based study technique that can enhance learning and long-term retention of medical knowledge. Medical students and schools could both benefit from understanding and using spaced repetition to produce more knowledgeable and better-informed doctors. Over a ...

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shutterstock_120079906 While examining a newborn baby for the first time, a mother happened to ask me, “Doc, what was your name?” “Dr. Bailony,” I replied. “Wow, that was the name of my pediatrician as a kid,” she said with a surprised tone in her voice. It turned out that her pediatrician as a young girl was my father, and by random chance ...

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