Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions.  In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting ...

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Nearly every day we read headlines about the serious prescription drug problem in America.  Increasing heroin addictions and deaths from illicit drug use are taking a severe toll on far too many families and communities. While we must feel enormous sadness for the families experiencing these tragedies, we must not overlook the other major health crisis that is often associated with the opioid abuse problem: chronic pain. The chronic pain crisis ...

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Top stories in health and medicine, August 11, 2014From MedPage Today:

  1. Psoriasis Ups Risk of Cancer, Serious Infection. Rates of malignancy among patients with psoriasis outpaced national averages, irrespective of therapy in most cases.
  2. Psoriasis: Screen for Fatty Liver Before MTX? What began as a case of chronic plaque psoriasis has evolved into consideration of routine testing for nonalcoholic steatohepatitis ...

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I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient.  That seemed self evident and logical.  "Do no harm" was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make "the right" decision for them -- not necessarily including them in the conversation or ...

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Ebola is a hemorrhagic fever that causes death by what seems like a virally induced stigmata. That statement could be even shorter. With a fatality rate that can reach 80 to 90% we could just say that Ebola is death. The World Health Organization (WHO) says this most recent outbreak is “moving faster than our efforts to control it” and the CDC is calling this “The biggest and most complex ...

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In a New York Times column, Thomas Friedman recent wrote about what Google values and seeks in its new employees. Striking to me was the fact that overall intelligence ranks lower on their values totem pole than several traditionally more important attributes. So, what can medicine learn from Google and how can we apply it to our admissions process? Here are five key points from the article, adapted to our admissions ...

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A primer on the anesthesia care team modelA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist.  Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician.  Once we get into the discussion, patients are also surprised to learn that ...

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10 potential benefits of robot caregivers My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy. I have to admit that my own first reaction to the topic was captured in the Times' letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … ...

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A wise friend who had completed residency told me prior to my starting training that the key to having fun was “never sit down when you get home from work.” Three years out of fellowship and practicing as a psychiatrist in Brooklyn, the words still resonate today.  The residents and medical students that rotate with me marvel at the stories of my full time acting career as a resident performing in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for a 5-year history of slowly progressive solid-food dysphagia that is accompanied by a sensation of food sticking in his lower retrosternal area. He has compensated by modifying his diet and avoiding fibrous meats. He has not lost weight, and he has not had trouble drinking liquids. ...

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I am so sorry I didn’t make this different for youThe telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before. I hesitated before calling her, recalling her mother’s cancer course. Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy ...

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Question: What do you do when presented with abnormal lab results? Answer: Ask lots of questions. The nursing home just sent over a urinalysis on a patient of Dr. Carlyle. I am covering his practice for a few days. The test showed that an 82-year-old woman had 3+ white blood cells in her urine. “NKDA” was written in the margin, indicating she had no allergies. I sighed internally and called the nursing home. ...

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Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war. There's a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative ...

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No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving ...

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There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes. In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician? Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha. Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of ...

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As doctors we prescribe a lot for our patients -- pain relievers, medications for specific ailments, exercise, or vitamins. However, too often we forget the power of vitamin C: human connection. As a therapist and medical doctor for children and adults with ADHD, I don’t underestimate the power of employing a variety of treatments that treat the patient as a whole; this may include medication, recommendations about diet, exercise and lifestyle ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is hospitalized for treatment of community-acquired pneumonia. Despite 4 days of treatment with intravenous fluids and antibiotics appropriate for the bacteria cultured from sputum and blood, he remains febrile with mild tachycardia. The patient subsequently develops mild hypotension and is transferred to the intensive care unit. Results of two ...

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OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.”  According to their website, three million patients now have such access, generally online.  Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others. Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary ...

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There’s been an ongoing court battle here in the state of Florida over whether physicians have the right to ask families about gun ownership in their home. The Florida Privacy of Firearm Owners Act was signed into law by Governor Rick Scott in 2011. This law prevents pediatricians from inquiring about gun ownership and discussing relevant safety information regarding how guns are stored and how to protect children from accidental injury. ...

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At the critical time when our nation has made meaningful and measurable progress against colorectal cancer incidence, threats to reimbursement for colonoscopy screening for Medicare beneficiaries are looming, which may jeopardize the effectiveness of public health strategies to increase screening and prevention of colorectal cancer in the U.S. New data from the American Cancer Society indicate that colorectal cancer has declined by 30% in just the last decade among those aged 50 ...

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