News non-flash: A comparison of various diets (low-carb/Atkins, low-carb + low fat/South Beach, low calorie/Weight Watchers, and whatever-the-hell-the-Zone-diet is/protein-carb ratio) shows no difference in long-term outcomes, defined as sustained weight loss, with the attendant presumed decrease in cardiovascular risk factors and events. Sorry, no great surprise here. But I think it’s because nutrition research has a huge blind spot: not adequately controlling for type 2 diabetes/metabolic syndrome. Let me explain. I have a hypothesis that ...

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shutterstock_223911598 I have issues with the customer satisfaction paradigm, but it’s not generally hard to make patients happy. Sometimes, though, it can be nearly impossible. It all depends on our own inner life as physicians and human beings. The key to medicine, to being a beloved physician, is to love our patients. This can be a tall order. Human beings are remarkably difficult ...

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shutterstock_2360943 Right now, there's nothing more angst-producing to physicians than maintenance of certification (MOC). Go to the physician-only message board Sermo, and you'll see dozens of threads on the topic.  Not surprisingly, all are negative. But rather than debating MOC itself in this post (if you want to do that, there are other places to do so), I want to take a step back ...

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Can primary care survive? At a time when the services of a well trained, well-supported primary care physician are needed more than ever before to help patients negotiate through the confusing health care maze, the specialty is under siege. We are overwhelmed. Those of us in primary care are overwhelmed by the growing weight of medical, legal, financial, and clerical responsibilities placed on our shoulders. The quality of care we can ...

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The truth is, I know it's easy to go to the Minute Clinic.  I know the enticement of not needing an appointment, of being able to shop while you wait, of having the prescription ready to pick up by the end of your appointment.  Who doesn't like convenience and a friendly smile to add?  Who doesn't like the customer service offered at CVS, Target, or your local pharmacy?  I certainly ...

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medpagetodayFrom MedPage Today:

  1. Should FDA Change Metformin's Black Box Warning? Diabetes experts are building a case to lift restrictions on using metformin in patients with moderate chronic kidney disease.
  2. Tacrolimus for Induction in Lupus Nephritis? Tacrolimus was found to be noninferior to mycophenolate mofetil (Cellcept) for lupus nephritis induction therapy when given ...

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Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the ...

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shutterstock_51888040 New York Post reporter Susan Edelman revealed the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY. Having her name made public will be a nightmare for Dr. Bankulla, as ...

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“What do you want for dinner?” I asked my wife. “I don’t know,” she answered.  “What do you want?” “How about hamburgers?” “No, I don’t want hamburgers.” “What do you want then?” “I don’t know … pasta.” “I’m a little sick of pasta,” I said.  “How about pizza?” “I’m really in the mood for pasta.” Silence.  Then:   “OK, pasta.” I’ve observed, both among my patients and my friends, that the issues which ultimately threaten to dismantle romantic ...

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shutterstock_153808931 You might think of bacon, that thing of gustatory beauty that is salted, cured pork, as just pleasure for your taste buds, however, one of the first medical facts I learned in 2015 was that bacon has medicinal purposes (apart from making you feel better after eating it). With this new knowledge at hand, the time just seemed right for a ...

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One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn't shocking. The patient hadn't been doing well lately, and I wasn't surprised when I got the message that they were on the way to the emergency room. Due to our ...

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seagull The day before I began my second year of medical school, I spent the day at the beach with my daughter, who had just celebrated her third birthday. Most of my classmates had spent their “last summer ever” traveling or doing research, but I had chosen to take the time off to make up for some of the family time I ...

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medpagetodayFrom MedPage Today:

  1. Whole Grains Reduce CVD, Total Death Risk. Eating a diet rich in whole grains was found to be associated with lower total mortality and deaths from cardiovascular disease (CVD), but not cancer.
  2. Tight Control Lowers Death in Type 1 Diabetes. Tight glucose control has a legacy effect of reduced ...

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On a 12-hour shift in the hospital, I recently spent a mere hour with patients, with the rest glued to a computer screen, to the "iPatient." When a patient comes to the hospital, speaking to them has become an afterthought to reading extensive medical records, physical exam findings from the emergency room, and synthesizing laboratory data. I, as a millennial doctor, have been on the cusp of this shift. My ...

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shutterstock_181449266 I truly love my job as an emergency physician. I think it's the best job there is in the house of medicine, melding the most ancient of medical traditions (abandoned by many modern practitioners) with the most cutting edge tools of medical technology. And really I never love it more so than at this time of year. I went into this field ...

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You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title. You are a doctor. But wait, you are not done yet. Want to be a cardiologist, oncologist or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest rate on that six ...

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My family and close friends have done so much for me since I became chronically ill in 2001, and I’m deeply grateful to them. I’ve written this piece because there are a few important things I want them to know about how I feel. Although this piece is personal in nature, I’ve been hanging out online for over a dozen years with other people who are chronically ill (which includes those ...

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Our current health care system will fail; it’s simply a matter of time.  Yet the delivery of efficient, quality, and progressive health care is quite possible once we shift our thinking.   A true paradigm shift in medicine begins with first establishing that each pillar in health care has an equal responsibility in making a new system work:  patients, providers, and places (facilities). This article pertains to only the provider portion. As ...

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Is it medically professional for a non-profit organization to use physician testing fees to "choose wisely" a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption. After a review of public and tax records, it appears to me this is exactly what has happened. Background In 1999 for reasons that ...

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medpagetodayFrom MedPage Today:

  1. Patients with peripheral spondyloarthritis responded to anti-TNF treatment. Patients with non-psoriatic peripheral spondyloarthritis (SpA) derived significant benefit from treatment with tumor necrosis factor (TNF) inhibition.
  2. Does Creatinine Say More About Muscle Quality than Mass? Urinary creatinine may be revealing more about muscle quality than muscle mass.
  3. 'Fat ...

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