Dont forget those where cancer screening didnt make a differenceI had the opportunity recently to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called "80 by 2018" designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence ...

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She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up. I sighed. "We've done the work-up and know this is not your heart. I don't think there are a lot more tests that can be run." I studied her expression, trying to discern what she wanted to hear from me. I've come ...

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Headlines soared recently with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years. “Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr. Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: ...

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Next in a series. Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the ...

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"I feel bad ..." Amy whispered, then paused. I'm a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I'd been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion. I'm a fan of Planned Parenthood's work providing high quality, affordable contraceptive and gynecological care. In ...

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From MedPage Today:

  1. White Boys More Likely to Be Color Blind. Color blindness is not colorblind, as it appears to afflict Caucasian boys at three times the rate of African-American boys.
  2. Boston Hospital Tackles Problem of Readmissions. Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates ...

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Most humans have spent most of human history nearly starving to death. So it’s no surprise that we spend a lot of time thinking about food. And it’s no surprise that food has acquired cultural, social, and religious significance in almost every society. Because food is so important, and because it’s nearly impossible for us not to ascribe powerful effects to anything important to us, every society imbues special health ...

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Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face. The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several ...

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It was a particularly challenging case.  On the car ride into the hospital, I found myself doing something that I rarely do.  I called a local allergist for an inpatient consult.  Most allergy issues are not an emergency.  So it is odd indeed to summon this particular kind of physician into the medical wards.  His nurse took the message and promised that she would plug my mobile number into his ...

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Projecting future physician workforce needs is a challenging calculation that must take multiple variables into account to avoid missing its mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large "physician surplus" and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program. Two decades later, there is a widespread consensus that the U.S. is ...

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One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine -- putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle ...

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The shocking ingredient in natural medicine So you think your medicine is natural. Ever wonder what’s inside? A product can be labeled “natural” if the main ingredient is from an animal, plant, or mineral. Arsenic, horse urine, and cow brain are natural. But are they natural for you? Here are four drugs whose origins may surprise you. Insulin was discovered in 1922. Until the 1980s, all insulin was “natural” ...

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From MedPage Today:

  1. ACA Signups Hit 7 Million Mark. More than 7 million Americans -- the avowed goal for 2014 enrollment -- have signed up for coverage through the Affordable Care Act's health insurance exchanges.
  2. Mixed Results in NSCLC, SCLC Trials. Two-thirds of patients with recurrent, mutated non-small cell lung cancer (NSCLC) responded to an investigational agent that selectively targets mutant cells and spares ...

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Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing ...

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On December 31, 2011 right before midnight, I took the test of excitement and new beginnings and found out that I was pregnant. While this news was joyous in nature, it was soon marred by uncertainty and harsh reality. After my test, I followed up with a doctor’s visit a month later, as was expected, and soon learned that the cost for this bundle of joy would be around $12,000 to ...

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Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it? Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn't get coverage. Are enough people getting coverage who didn't have it before to justify the sacrifices the people who were already covered -- in the individual, ...

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A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you ...

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If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the ...

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Allow me to describe a recent case and ask your opinion.  Today, you are the intake nurse at hospice and you are asked to evaluate Stan.  This gentleman has incurable cancer, but treatment would probably prolong his survival.   However, Stan has refused that treatment and been referred to you.  It is your job to decide if he is “hospice appropriate.” Why has Stan refused therapy?  It is not that he denies ...

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From MedPage Today:

  1. How to Replace IV Nitroglycerin in the Shortage. For the last month, Nadia Awad, PharmD, and her ED team at Somerset Medical Center in New Jersey, have struggled with a shortage of nitroglycerin.
  2. FDA Panel Gives Nod to New Antibiotics. Two new antibiotics aimed at acute skin and skin structure infections each got unanimous approval Monday from an FDA advisory committee.

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