Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He ...

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It used to be that the greatest cost at a doctor’s visit was paying for the visit itself. Nowadays, the office visit is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help with the un-Affordable Care Act. In the last few ...

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A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It ...

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To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger. The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In ...

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Proton beam therapy: We need more than informed hope on social mediaI had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed. In the morning ...

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Many of our patients are besieged with unsolicited Internet advertisements offering them unbelievable solutions and cures to most of mankind’s medical maladies.  Patients come to and ask for advice about these promises to magically restore their health. Since I receive so many requests from patients to evaluate these offerings, I have put together five questions that patients should ask themselves before proceeding to buy from websites offering outlandish claims, including restoring ...

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Its time to talk trade offs in health care An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking ...

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Top stories in health and medicine, October 10, 2014From MedPage Today:

  1. Aphrodisiac Aids Genetic Type 2 Diabetes. The stimulant yohimbine may improve insulin secretion in type 2 diabetes patients who have a genetic risk for the disease.
  2. Ebola: Second Texas Man Assessed. A new patient is being assessed for Ebola in the Dallas hospital where the first U.S. patient died.

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Media deprivation: Do you think it exists? Although laughable at first glance I know I’m not the only parent who wonders if limiting screen time could change my child’s opportunity. Those of us who fiercely control screen/device time may have momentary lapses where we wonder if we’re doing things right. Even though I’m convinced there isn’t a study telling us that typically-developing children need media/apps/screen time to learn how to ...

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The recent independence referendum in Scotland got me thinking. I must admit I was glued to the news over the last few days of campaigning. For those of you not following closely, it seemed as if the "no" camp had a comfortable lead right up until the last week when the opinion polls suddenly showed the "yes" camp pulling ahead. This rattled the establishment. The prospect of my country of ...

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About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then. Consider that we are now a year in to the implementation of the ...

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As we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan. Sorting through policies was tough already, but now insurers are making it even harder by changing the way they will cover generic drugs. It used to be that opting for generics was a snap. Health plans usually offered three or four tiers of drugs -- one for ...

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I saw another exciting news story on a mobile health intervention the other day.  I honestly don’t remember the company or product, but what stuck with me was the declaration of success based on 10 patients using the product for three months.  Success was touted in terms of cost reduction and resource utilization reduction in a before/after analysis.  This inspired me to collect some thoughts on some of the challenges ...

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He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  "They offered me peritoneal dialysis," he said, "but I decided against it and figured I'd just let nature take its course.  The hospice people are so wonderful -- I've got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, ...

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Top stories in health and medicine, October 9, 2014From MedPage Today:

  1. Obese Kids Face Greater Risk for Heart Disease. The adverse long-term influence of obesity and elevated blood pressure on left ventricular remodeling begins in childhood, according to findings from the world's longest running biracial heart study.
  2. IBM's Watson Comes to the Bedside. If a physician or a patient could ...

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A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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I direct a nutrition clinic in a large center for children with special needs. My kids can have everything from mild learning disabilities to genetic disorders that affect growth and development to profound intellectual and physical impairments that cause them to be unable to walk, speak or even scratch their heads. My most seriously involved kids are completely dependent for all their care. Children who are somewhere in between -- for example, children who ...

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Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. Because of the concern for aspiration, an ambulance was called and the child was taken to ...

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“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.” I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with ...

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Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of ...

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