The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues. Strange ...

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SGR has been the bane of my time in policy.  And I want it to be yours. SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good ...

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shutterstock_127842695 Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt.  Would the next organic chemistry exam eliminate my 3.99 GPA?  Would the MCAT decide what medical schools would immediately ignore me without ever meeting me?  Would the sheer volume of material weed out the persons sitting next to me in medical school or ...

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medpagetodayFrom MedPage Today:

  1. Uncertainty and Litigation Fears Drive ED Docs to Overimage. Nearly all emergency medicine physicians responding to a survey said that at least some of the advanced imaging studies they ordered were medically unnecessary.
  2. USPSTF: Not Enough Evidence for Thyroid Screening. The U.S. Preventive Services Task Force (USPSTF) said there ...

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Medicine is obsessed with numbers.  Or rather, journalists and medical administrators are.  Here are two related examples of how large a grain of salt one must put on numbers. Cardiac surgical procedures, like everything else in medicine, have quality indicators.  One of these is what we doctors call “30-day mortality.”  What this term means is that surgeons are evaluated in part on how many of the patients they operated on died ...

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Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to ...

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Question: My family (including two small children) and I are relocating this summer for my husband’s new job after seven years of living in the same area for residency and fellowship to a city where I know no one. I am scared about leaving our support network of friends and family nearby. Can you offer advice on starting over in a new place? Answer: I would guess that almost every physician family has ...

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When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked.  My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work.  Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward ...

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The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t. The U.S. lags behind other industrialized nations in many important health measures -- partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious -- but we’ll explore some ...

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An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort ...

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medpagetodayFrom MedPage Today:

  1. OA Patients Don't Face Higher Heart Disease Risk. Neither radiographic nor clinical osteoarthritis (OA) was related to a greater risk for cardiovascular disease (CVD) in older patients.
  2. Senators to Providers, Industry: Lobby Harder on End-of-Life Care. A strong coalition is needed to transform care for the dying, said U.S. ...

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As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies. As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is an exception that can make you realize that there ...

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Eonia I Mnimi (Eternal Memory)  - Greek Orthodox Funeral Blessing “Have you ever seen anyone die before?” my cousin asked me, from across the bed. “Sure I have, plenty of times,” I answered. We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath. *** My uncle had been declining for several years with 
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I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked. I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at ...

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When he and I first met, he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!” I did. The next week, he answered my questions about the pencil drawings on his walls. “My name ...

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shutterstock_50580199 As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of ...

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Ever heard of a doula? Doula is an ancient Greek word that translates as “woman who serves.” Specifically, it’s come to mean someone who serves as a birth attendant, a person trained in childbirth who acts in support of a birthing mother. A doula provides knowledge, comfort, and an extra pair of hands -- whether it’s to provide nourishment or massage, or help a mother find a comfortable position. As you may ...

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medpagetodayFrom MedPage Today:

  1. Retooling the Health Hazard Survey. "Oral sex? Anal sex? Fetishes?" These are questions on the patient intake form at AlphaBetterCare, an LGBT-friendly primary care practice owned and operated by Howard Grossman, MD.
  2. Orthopedists' Financial Conflicts Can Hurt Patients, Surgeon Says. Financial conflicts of interest often drive physicians to perform ...

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shutterstock_263182502 Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession -- usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor ...

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I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab, waiting to see our cadaver for the first time. Our group enters, and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy ...

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