Solving the mid level dilemma: Call them what they really are Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: "Stop calling nurse practitioners mid-level providers." So do I, though my reasons are a bit different.  In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know ...

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Top stories in health and medicine, August 26, 2014From MedPage Today:

  1. Adrenaline: The Best and Worst of Drugs. Despite it being the first-line adrenergic drug for patients with cardiac arrest, few studies in humans have assessed epinephrine's effectiveness.
  2. Increase E-Cig Regulation, Says AHA. The federal government should ban the sale of e-cigarettes to minors just as it does cigarettes and ...

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"If a tree falls in a forest and no one is around to hear it, does it make a sound?" Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn't know what's ...

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When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s.  As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly ...

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Several months ago, a post called, "Everything's my fault: How a surgeon says I'm sorry," appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else. She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to ...

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I must not be the only person to wonder how pharmaceutical companies succeed with direct to consumer advertisements when, stuck in the middle of all their TV ads, are those long lists of side effects.  You know what I mean.  After watching a smiling and attractive person running through a field after receiving some wonder pill, the narrator tucks his voice down an octave and intones that the medication “could ...

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In an ironic analogy to the recent Occupy Wall Street movement publicizing the wealth gap between America’s elite and the general public, the health care world also has its own infamous 1%. According to the Agency for Healthcare Research and Quality’s 2012 report, the top 1% of health care seekers incurs nearly a third of the nation’s $1.26 trillion yearly health care expenses (and up to half of this expenditure ...

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Part of a series. A common criticism of direct primary care (DPC, membership/retainer/concierge practices) is the added expense: “Isn’t it too expensive?” Ways to think about the cost are to prioritize expenditures and to consider potential savings that make it cost effective. I gave examples of three direct primary care practices in an earlier post. Here is a recap of costs. AtlasMD’s annual fee is $600 for a young adult and ...

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Top stories in health and medicine, August 25, 2014From MedPage Today:

  1. Futile ICU Care for Some Delays Care for Others. Providing futile care to ICU patients delayed care for other patients awaiting transfer into the ICU, according to a 3-month study of ICU practices at two hospitals.
  2. Lupus and the Atomic Bomb? In the early 1950s, with the expanding arms ...

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If you’ve ever worked in an emergency room, you’ve likely treated a victim of human trafficking. We all have, often without knowing it. With nearly thirty million people in modern-day slavery around the world, there are more slaves today than at any point in history. Human trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion” for the ...

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A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience ... until then. That night, the restaurant was packed as they were offering half-priced desserts. My husband and I arrived first. I noticed when we ordered ...

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My high school graduation ceremony was your typical Californian high school graduation -- the sun hovering lazily over us, a cool, ocean breeze bringing wafts from the sea. As I listened to my principal deliver his address, my attention waned in and out. The sun was too warm and the wind was too soft. When the student speaker came up to speak, I reclaimed my attention to listen to him ...

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Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct ...

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Most hospitals are strapped with a massive amount of debt.  Not monetary debt, but sleep debt.   Amongst both the staff and patients, sleep is severely lacking.  In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day.  But sleep isn’t a luxury.  Rather, it’s a medical necessity. Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started ...

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I wholeheartedly support the message behind the project, What Works For Me. As health care professionals, we continually encounter human suffering and work under stressful conditions. As a family physician for the past 14 years, I have been fortunate enough to work in a variety of clinical settings, including several in general family practice. Currently, I practice family medicine in the sexual health clinic of a community health center. ...

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The big day has finally arrived. Your boss shakes your hand and wishes you well. Your colleagues gather around a cake and make small talk about landing the big fish in your retirement, or joke about what you’ll do now that you don’t have to come to the office. A cardboard box is filled with the contents of your desk: your family pictures, desktop trinkets, snowball paperweight, and stale candy. Your ...

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There are many reasons why the costs of delivering simple, uncomplicated health care in this country keep increasing while quality lags and value fails to keep pace with that of most major industrialized countries. But as a surgeon, I have a one-word answer for all that is wrong with health care: “robots.” Surgical robots, costing an estimated 1.2 to 2.5 million dollars each with matching maintenance fees of $125,000 per year, ...

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We live in a digital age. Technology has become an integral part of how we see, learn about, and interact with the world. From computers at the office, to televisions at home, to smartphones on the bus or in the grocery line, many of us spend over half of our waking lives in front of a screen. Naturally, some of us have begun to worry about the effects this may have ...

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Today, I saved a life. And I wish I could tell you a story about fancy heroics -- about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life.  But I can’t.  But I can tell you that I saved a life. She was 16-years-old, and moved here four years ago from a different ...

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