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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Top stories in health and medicine, October 2, 2014From MedPage Today:

  1. Vitamin D No Help in the ICU. Trying to correct vitamin D deficiency in the ICU won't improve outcomes.
  2. Ebola: CDC Confirms First U.S. Diagnosis. A man in intensive care in Dallas is the first person to be diagnosed with Ebola in U.S.
  3. Exercise and Diabetes: Calculating ...

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As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it. In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist ...

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Part of a series. Comprehensive primary care for employees means better employee health, greater productivity, less presenteesism and lower costs for both employee and employer. That is why some companies are making health care a strategic imperative rather than just a tactic as part of human resource cost management. Some are developing full service enhanced primary care clinics on site with excellent success as described in my last ...

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The dark underbelly of health care is becoming all too visible now. Fresh faces in neatly pressed white coats are in the halls.  Eager.  Enthusiastic.  Clearly very bright.  All hoping for a moment, an experience, an encounter that makes all their hard work worth it.  Surely they'll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights. He was a doctor ...

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Every year, ambitious students from around the world flock to America’s leading business schools, hoping to learn how to create new ventures that can change the world. On the West Coast, situated in the heart of Silicon Valley, Stanford University’s Graduate School of Business attracts budding entrepreneurs with challenging and practical programs. Courses like “Entrepreneurship: Formation of New Ventures” and “Managing Growing Enterprises” encourage students to develop innovative business models that solve real ...

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The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,"Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life." This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand.   They conclude, as has been said before, that we waste ...

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Respiratory syncytial virus infection, aka RSV, is a common infection in children. A key aspect of RSV is how poor a job our immune systems do in fighting it off. Virtually all children are infected with RSV during the first few years of life. Not only that, all of us are reinfected multiple times during our lives. Attempts at devising a vaccine for RSV have all been unsuccessful. In fact, ...

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

  1. Targeted Drugs Build on Efficacy Record in Melanoma. Targeted therapy solidified and clarified its role in the treatment of advanced melanoma, as studies showed superiority over chemotherapy, and that two targeted drugs outperform one.
  2. Fish Oil Flops Again in Afib Study. High-dose fish oil failed to reduce atrial fibrillation ...

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Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths. Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification ...

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ZDoggMD's latest parody.  This time he takes aim at Garth Brooks in "Friends With Low Platelets." "I’m not big on thrombopoiesis. Think I’ll skip on down to plasmapheresis. 'cause I got friends … with low platelets." Classic.

The ALS ice bucket challenge, better known as #ALSIceBucketChallenge or #icebucketchallenge, was almost the perfect storm for viral fundraising. In my course, Designing Health Campaigns Using Social Media at Tufts University, we analyzed why the challenge went viral. Not surprisingly, given its popularity, my students had all heard about it and watched challenge videos. About half had done it. Some researched amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, and ...

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My life changed dramatically when I started my new practice.  The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new.  That's a tough thing to do with four kids, three of whom were in college last fall.  OK, that's a stupid thing to do, but my stupidity has already been well-established. Yet even if the income stayed ...

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Few medical interventions have been as successful as vaccines in improving public health. Whether they are childhood vaccinations, vaccines to prevent healthy adults from contracting influenza or the more recent HPV vaccine for adolescents, these preventive methods have resulted in dramatic benefits for individuals and the public. We have only to think of the eradication of smallpox and the virtual eradication of poliomyelitis to see the enormous benefits vaccines can bring. ...

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It had been crazy busy all night in the emergency department and I had been running from room to room patching holes and trying to get patients seen. I felt behind all night.  Finally, I had a moment to collect my thoughts and turned my attention to a patient who had been waiting for quite a while. This patient had multiple large and deep lacerations to his forearm, self-inflicted wounds caused during ...

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I recently treated a patient who was hospitalized with paraplegia. During some routine lab testing I noticed that his liver function tests were elevated, and so I began looking for a cause. I discussed the patient’s drinking habits (he rarely drank alcohol), risks for viral hepatitis (no IV drug use or exposure to those with known hepatitis), and general medical history (nothing relevant to liver disease). I reviewed his current ...

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Top stories in health and medicine, September 30, 2014From MedPage Today:

  1. Data Confirm Anti-ALK Activity in Rare NSCLC. Objective responses occurred in 72% of patients with mutation-specific non-small cell lung cancer (NSCLC) treated with crizotinib (Xalkori).
  2. Case Reports: PET Imaging in Dementia. In two cases of progressing dementia, PET imaging with amyloid and tau tracers helped to clarify the diagnosis ...

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I’ve been toiling in the field of connected health for 20 years now, watching for signs of adoption that will move us into the steep part of the curve.  I have to wonder, with announcements from several huge consumer companies recently, if that time is coming. By now you’ve heard about Apple’s HealthKit announcement, which involved not only Apple, but Mayo Clinic and Epic. Samsung is not sitting still, having released increasingly ...

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