3 ways to make health IT work better for nurses The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting. The theory behind this push, which is part of the federal government’s meaningful use policy, ...

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Everyone cries when they bury their dead When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to ...

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If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team. I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own. Admittedly, it’s not quite the surgeon general who ...

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Consider the lipstick sign in your next physical exam The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning. Fine motor skills and concentration can be correlated with a positive ...

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

  1. CDC: HIV Remains Uncontrolled for Most Patients. Only three Americans in 10 with HIV had the virus under control in a 2011 snapshot of the epidemic, the CDC is reporting.
  2. Atherosclerosis a Signal for Brain Drain? Asymptomatic atherosclerosis could be a warning sign for cognitive impairment risk.

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The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp. As an OB/GYN I want to tell you how bad this actually is. The most ...

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Trivializing the significance of losing one’s hair during cancer treatment Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential ...

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$2.6 million: Is the cost of becoming a doctor worth it? Each year, over 20,000 U.S. students begin medical school.  They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000.  That’s a lot of money.  But for some who pursue careers in medicine, the financial cost has been considerably greater.  Melissa Chen, 35, a final-year radiology resident at the ...

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Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients.   Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice.  I agreed to the terms and conditions of any large ...

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I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together. When I first worked here, 2 years ago, they ...

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Why do hospitals feed their staff so poorly? Why do hospitals feed their staff so poorly? I recently visited a friend who works at Google and was pleasantly surprised by the Bay-area tech giant's health-promotion efforts. Its crowded cafeteria offered mostly healthy food, with low-fat, low-carb, and high-fiber delicacies. Any dietitian would have appreciated the plethora of organic dairy products, the salad servers filled ...

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A sleeping dragon awakes. At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO. The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated following a recent diagnosis of type 2 diabetes mellitus. On physical examination, blood pressure is 134/84 mm Hg; other vital signs are normal. BMI is 30. The remainder of the examination is unremarkable. Laboratory studies show an HbA1c of 7.8%, blood urea nitrogen 15 mg/dL (5.4 mmol/L), and serum ...

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After the 2014 elections: Is Obamacare safe? By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it.  But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions ...

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How to choose a good hospital? Hint: Dont listen to the ads. Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don't find their news worth passing along, but occasionally a pitch sparks a column idea. That's the case with the press ...

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“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed. I was also shaking. I had been covering nine patients that night. Almost none were stable. In the span of one shift, we called three rapid responses. One person went into cardiogenic shock right in front of me was transferred to ...

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Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust ...

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Having children during medical residency: 6 tips to survive We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter -- and who can ask for anything ...

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Autism was first reported in the medical literature 70 years ago. In 1943 a child psychologist named Leo Kanner described a child with social difficulties and repetitive, stereotypic movements; the following year Hans Asperger described four such children. Since then we have gradually learned more about what we now call autism spectrum disorders (ASD), although we still do not know what causes it. From early on it was apparent that the ...

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At a recent conference I was approached by more than a few colleagues and asked about the Kardashian Index (K-index). For those oblivious to the term, K-index is a ratio of a researcher’s Twitter followers (as a measure of “celebrity”) over the number of their research citations (as a measure of “scientific value”). The article implies, and I quote: “A high K-index is a warning to the community that researcher X may ...

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