Working the night shift as a resident physician You’ve changed. No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other. We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night.  Your persistence to move ...

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Top stories in health and medicine, August 1, 2014From MedPage Today:

  1. The 40-Minute Office Visit. The State stopped by to see us the other day. Wow, that sounds ominous.
  2. FDA to Expand Reach on Diagnostic Tests. The FDA plans to take over regulation of "home brew" diagnostic tests developed and used within individual clinical laboratories.
  3. Lytics for Stroke ...

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I’m a second-year medical student, and quite recently, a lecture left me with serious doubts about the state of social awareness in the medical field and schools. The dermatologist lecturing described a patient with secondary syphilis, stating he felt the case was odd since, “He [the patient] didn’t look gay or anything,” as if only homosexual men could contract that disease. I was hurt. I not only belong to a racial ...

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There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this ...

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I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is ...

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I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids!  Eczema? Steroids!  Psoriasis? ...

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There is no doubt that Affordable Care Act has changed the landscape of medicine in the U.S.  Now, private practice is becoming a thing of the past. Financial pressures, increasing regulatory requirements, electronic medical records and outrageously complex coding systems are forcing long time private physicians to enter into agreements with academic centers and large hospital systems in order to survive. As a result, medicine today is more about increasing patient ...

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Ask almost any physician why they chose medicine, and they'll answer, "I wanted to make a difference in the lives of patients." But in today's high-pressure healthcare environment, it's easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, "It's OK, as long as we're delivering great clinical care, we're delivering great care. After all, the massive heart attack was averted. The wound was stitched. What ...

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It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of ...

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Whether you’ve praised or vilified Obamacare, see it as an amazing achievement or an existential threat, it is the law of the land.  The price transparency created by online exchanges, a vital part of the law, stands to make cost the biggest driver of choice. This, along with cuts in government health spending, will disrupt the economics of health care in dramatic new ways. Our first response to this brave new ...

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Top stories in health and medicine, July 31, 2014From MedPage Today:

  1. Florida 'Gun Gag' Angers Medical Societies. Medical societies condemned the federal court decision allowing Florida to forbid physicians from asking patients if they keep firearms at home, with severe penalties for violators.
  2. Compromise Reached on Vets' Healthcare. Congressional leaders appear to have reached a compromise on a bill to ...

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When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why.  We try to learn if there’s anything we could have done better and what we should do next time. It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference.  It was ...

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As a medical student, it’s difficult to face a situation where everything possible is done for a patient, yet due to circumstances (seemingly) beyond our control, the risk of future harm remains uncomfortably certain. The majority of our medical school learning focuses on how to cure illness; unfortunately we’re not always taught how to deal with the real world issues that face our patients and that threaten the medicine we ...

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After serious self reflection, is there redemption for Dr. Oz? Recently, Dr. Oz has come under scrutiny for his information on a number supplements that he alleges help with weight loss. Over the past 2 years, he has presented information about 3 diet supplements: green coffee extract, raspberry ketones and garcinia cambogia. After reviewing the available information, I can not agree that there is compelling scientific information to recommend ...

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This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here's my answer to the question, "What should I look for in a good family medicine (FM) residency program?" It's FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that's in line with the Accreditation ...

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At a crowded townhall meeting in 1959, an elderly woman stepped up to the microphone and spoke to a panel of senators. "I am not worried for my son's time," she began. "He is 35, and I am sure he will face a better future when his time comes to retire. But what is to be done for those of us who need help right now?" This was one of a ...

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Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine. But in today’s practice of medicine, that’s not enough. Physicians, ...

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This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,"Sliver of Medicare Doctors Get Big Share of Payout." Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization ...

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We've all come to expect our doctors to run late for appointments. I’m a doctor, and when I go to see my doctor, I expect the same. I bring my laptop or something to read to bide the time. Waiting makes us feel like we or our time isn’t valued, and doctors know this. So why is it so hard for doctors, including myself, to stay on time?   Most doctors have ...

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Though there have been notable exceptions, digital health has often proved a slow sell to the medical establishment. The failures of Google Health and HealthVault to gain traction, for example, underscore the challenges of breaking into the workflow of doctors. Yet over the past month, three technology giants have, in the form of a series of launches, given an endorsement that digital health will be one of the next important technological ...

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