The Ebola outbreak: Dont blame the nurse There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in Liberia. Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. ...

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I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant. The telephone rang with the caller ID identifying a call on my office work line. “Hello this is the emergency department, please hold on for Dr. S.” ...

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Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence. As is ...

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Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits. Unfortunately, too many Americans lack easy access to primary care.  Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. ...

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The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications ...

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How to improve doctor administrator relations A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks ...

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Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola. Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also 
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The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public -- and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed. As a result, the responsibility ...

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Dr. Danielle Ofri has an important piece in the New York Times: "The Physical Exam as Refuge." As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition? While I did outpatient medicine for ...

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Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks. Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ ...

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There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald's that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances.  Or at least that is how the proponents of algorithmic medicine see it. In addition, electronic health record systems create uniformity by enforcing ...

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The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That's more than the total number of cases in any year since 2000, when measles was eliminated in the U.S.. We have got to get more people immunized. Essentially all of the cases were linked to "importations," cases brought in from other countries ...

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Top stories in health and medicine, October 3, 2014From MedPage Today:

  1. Best Aortic Valve Type in Middle Age? Bioprosthetic aortic valves didn't compromise long-term outcomes for middle-age adults compared with mechanical valves, although there were some tradeoffs.
  2. Burnout 'Across the Pond' More than 70% of young oncologists in Europe are showing signs of burnout.
  3. Ebola: Dallas Case Inevitable ...

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We’re born into our bodies, and we take that for granted. Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about.  That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world. Before we’re born, all our needs are met via an artery and ...

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study published in the journal Pediatrics showed that young fathers, those who became dads at an average age of 25 years, have a 68% increase in depression symptoms within the first five years of becoming dads. This applied to young dads who lived with their children and their wives or girlfriends. Dads who lived away from their children and older fathers did not show that same increase in rates of depression. ...

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Faxes! Who still uses faxes? The medical industry does. Here is a picture from just today: 27 faxes received and about 20 sent, and that is only counting after noon. Some days are worse, with up to 40 faxes to handle in our small medical practice. Who still uses faxes? The medical industry does. On the left are the 27 faxes received: We use e-faxing, so they arrive as pdfs. On ...

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Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform. After almost a decade of practice, the fact is that I like my job. Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when ...

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The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is to ...

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I have written a couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email, but take out identifying information to protect his anonymity. Here’s what he ...

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