I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose -- a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure ...

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Get a group of health policy experts together and you’ll find one area of near universal agreement: We need more transparency in health care. The notion behind transparency is straightforward; greater availability of data on provider performance helps consumers make better choices and motivates providers to improve. And there is some evidence to suggest it works.  In New York State, after cardiac surgery reporting went into effect, some ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg ...

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Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person diseased: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false negatives and false positives. To ...

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The USA trains its physicians differently from every other Western country I know. Everyone (with rare exceptions) who goes to medical school first must get a four-year undergraduate college degree in something. There are no such degrees in medicine, although the overwhelming majority of students going on to medical school major in one of the sciences, such as chemistry, biochemistry, and biology. If they don’t major in a science, they generally ...

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One of the topics’s that I’ve written most about, and also do a considerable amount of non-clinical consulting work on, is how we can improve health care information technology and electronic medical records. As they currently exist, there are unfortunately many drawbacks to health care IT systems, and they have as yet failed to fulfill their immense promise. I’m not a technophobe by any stretch of the imagination. I embrace technologies and ...

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When my father died three years ago,  my comments at his funeral noted that the greatest aspiration any of us can have is to make a difference in the world.  My father’s life made a difference. I’m always self-critical and analyzing my own life.  I moved to Boston 20 years ago this month.   In those 20 years of service to Beth Israel Deaconess Medical Center (BIDMC), Harvard, numerous federal organizations, ...

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Most primary care physicians (PCPs) who admit patients to a hospital are family practitioners or internists. Since medicine becomes more complex each day, PCPs must remain up-to-date on the latest treatment related to drugs, surgery, procedures, risks, complications, and costs. This might require your PCP to be a quarterback bringing together a team of consulting specialists to guide you through your hospital stay. The economics of hospitalization are changing, and since ...

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"Was the delay in deciding to open influenced by the presence of an audience of 100 surgeons expecting to see a laparoscopic liver resection?" “In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.” As I predicted last year, it had to happen sooner or later. In that post, I wrote, “A major complication ...

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I love being an academic pediatrician.  I didn’t start out to do that; I thought I would be writing novels and working part-time in an inner-city clinic.  I wrote with Robert Penn Warren in college and my first (and only) novel was published when I was a senior in medical school.  But things don’t always turn out the way you expect them to.  In my case, I didn’t expect to be ...

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Ever wonder where tissue samples go after they're taken? The College of American Pathologists shares their journey in this video.

When, aged thirteen, my best friend died of complications from sickle cell disease, her parents could not attend her funeral, or find out where she was buried. My mom explained to me that in the Yoruba culture, because parents are not expected to survive their children, it is considered an abomination for a parent to know where their child is buried. So, the young adults in the extended family attended ...

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The American medical establishment has systematically clogged his arteries with paperwork, lined his lungs with rules, and filled his intestines with, that’s right you guessed it, shit. There he lay, in a comatose state, awaiting to be pronounced. Only one thing is sustaining his overworked body. Idealism. Four months into my intern year and I’m just realizing how crucial maintaining my idealism -- as unrealistic as it may be -- is to ...

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They played Taps at my dad’s funeral. Two teenagers on trumpets. First, the girl, positioned to the back and left of the crowd. Ta-ta-dah, she starts boldly, without the unease of her youth. Each simple note pierces the dry winter air. Yes, you have our attention. Not another sound. Not even a breath by gathered friends and family. In time, the second musician’s reply from the front. Ta-da-dah. And a pause. Their ...

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Wes Fisher recently took his case against MOC to the AMA House of Delegates.  Watch how it went.

“Hey, doc, you’re killing me.” Or, more specifically, us. A recent report from researchers at the Johns Hopkins University School of Medicine points to medical errors as the third leading cause of death in this country. Despite the many safeguards put in place by the government, hospitals, and doctors, themselves, more than 250,000 people a year in the U.S. die from hospital-acquired infections, wrong-site surgeries, medication mistakes and a host of ...

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A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh. Now add 43 more patients. Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to ...

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A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t. I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I ...

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In the hallway the other day a colleague stopped me and said, "Hey, do you want to see something funny?" "Sure," I said, and he showed me the YouTube video called "How Anti-Vaxxers Sound to Normal People."  The video highlighted that those who choose not to vaccinate themselves or their children do so for reasons that do not make sense, and frankly seem somewhat absurd.  It is a very ...

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Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis -- numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into ...

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