Apps used to monitor blood pressure need better design Here's a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps. I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at ...

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Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid? The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and ...

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I recently spoke to a quality measures development organization and it got me thinking -- what makes a good doctor, and how do we measure it? In thinking about this, I reflected on how far we have come on quality measurement.  A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or ...

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Malcolm Gladwell thinks we should tell people whats it's really like to be a doctor.  And by God I have invested the last seven years in doing just that.  I have written countless blogs, given lectures, and traveled to Ireland.  I have coined the term Caring 2.0 to describe the bidirectional flow of empathy.  Patients will tell us what it is like to suffer with disease, and we ...

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From MedPage Today:

  1. BP Control May Cut Second Stroke Risk in Half. Stroke patients do a poor job of consistently controlling their blood pressure, but those who do may cut their risk of having another stroke in half.
  2. Debulking, IP Chemo Best for Ovarian Ca. Optimal surgical debulking and intraperitoneal (IP) adjuvant chemotherapy afforded patients with advanced ovarian cancer the best outcomes in a ...

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Should medical school be shortened to three years? I say, "no." Here's why. There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase -- residency training. I do not see how medical students can choose a career path before they have ...

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For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters -- that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off. We are making the foreign affairs case the wrong way.  Rather than argue the positive merits of trade or the negative repercussions of unchecked ...

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I believe that family medicine is the solution to American health care. I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care to specialty care have populations who live longer and health care that costs less. Too many specialists and not enough family physicians leads to unnecessarily expensive care and shorter life expectancy. I believe that family doctors provide something intangible to our ...

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From MedPage Today:

  1. Brain Structure Disrupted in Autistic Kids. Autopsied brains of autistic children showed "patches of disorganization" not seen in otherwise healthy children.
  2. Weight-Loss Surgery: It's Not Just About Stomach Size. An increase in bile acids, not just smaller stomach size, helps promote weight loss and better glucose control after vertical sleeve gastrectomy (VSG).
  3. Small, Frequent Meals Don't Rev Metabolism. Dieters ...

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I have a confession. It is a secret I have held for more than 10 years and it is a lesson I have learned from other women. As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise ...

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Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients. But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, ...

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The surprising way patients get drugs Tom is diabetic, asthmatic, and broke. He’s back for a checkup. “I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.” “How did you get extended release? They’re super expensive.” “Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she ...

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Readers know that I am skeptical over the efficacy of complementary and alternative medicine. This is not merely a demonstration of my inborn skepticism, but doubt based on the fact the so much of their claims are untested, unproven and refuted. I don’t regard the above comment as controversial. It is factual. I’ll let readers decide if it is but another example of the arrogance of conventional physicians who worship on ...

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They used to tell us, as physicians, that "if it isn’t on the chart, it didn’t happen."  We could protest all day, to billing companies, insurers or attorneys, "I did that.  It’s assumed.  I always do the same thing every time."  But they would retort, "nope, it’s not in the chart."  So we learned to detail everything, every time, every movement.  Every consideration and justification.  The idea being, our ‘thought process’ ...

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There's a bit of buzz in the news recently over President Obama's nominee for surgeon general, Dr. Vivek Murthy. It's worth pausing here to note the last truly consequential surgeon general:  Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration's AIDS response (to be clear -- this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard ...

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Clinical medical research -- finding out which treatments help and which ones don’t (or even make the situation worse) -- is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is ...

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“I walked in a person, and out a cancer patient,” my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine -- the side on the exam table or gurney, as opposed to the one standing over it. As a physician I was used to the latter. This is my family’s story in our new position, and how the cost of medical care has impacted ...

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NephMadness 2014: Lets reinvigorate nephrologyThe field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s ...

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From MedPage Today:

  1. FDA Staff Doubts Colon Cancer Blood Test. FDA staff expressed serious reservations about using an investigational blood biomarker test as a colorectal cancer screen, citing poor specificity and unanswered questions about other purported advantages.
  2. Weight Gain Soon After Birth Tied to Diabetes Risk. New moms who add extra pounds to baby weight within a year of giving birth increase their risk ...

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Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way ...

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