Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter. The second sheet, mysteriously, contains only a single line: This page intentionally left ...

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As I walked home last night I glanced up at the evening sky of Dominica. Twinkling down at me was what seemed like a surprisingly bright star compared to all the rest. It couldn’t be a plane because planes very rarely fly over this Caribbean island. It seemed to be stationary so it couldn’t be a meteor. Confused, I pulled out the sky map on my iPhone and discovered it was ...

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

  1. U.S. Healthcare: Still Pricey, but Getting Better. Healthcare costs in the U.S. remain the highest per person, but expenditure growth has slowed in the past decade, bringing the nation's health budget more in line with other countries.
  2. Pelvic Exams: Comments From Clinicians. In a new clinical guideline released Monday, ...

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If you pay close attention to medical education and training, you have surely read something like this as an goal or learning objective: “Manage inflammatory bowel disease and its complications.” However, this is not exactly what our goals should be. One push in the patient-centered care community has been changing the focus from managing the disease to managing the patient who has (or might have) the disease. The difference in wording is subtle, but it gets more ...

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There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential. Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals ...

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As a resident of San Francisco (and with Los Angeles just a drive away), I cannot escape the food hate.  Whether it be a campaign against cooked provisions, farmed products or anything of solid consistency, I cannot help but wonder if any possible benefit of these diets outweigh the risk of missing out on amazing grub. But what about gluten-free diets? Gluten sensitivity Gluten, a protein found in foodstuffs such as wheat, barley ...

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We recently took our last exam as first-year medical students. Sitting in the same library that I used to as a pre-medical student, I thought about what it was, exactly, that changed this year. For me, the point of transition from pre-med to med student really happened over last Thanksgiving break. I had come home from my first term of medical school more ready for my mom’s hugs and homemade banana bread ...

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I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your ...

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Complicated medical procedures can be dangerous, even when done by highly skilled and experienced people. Why? Because, irrespective of the procedural risk itself, all of us are human and we can overlook or forget things, no matter how many times we have done the procedure. This was recognized many years ago in the airline industry. Flying an airplane is a complicated and potentially dangerous activity and their are many steps ...

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

  1. Supreme Court Issues Hobby Lobby Decision. The Supreme Court has struck down the Affordable Care Act requirement that employers must include no-cost contraceptive coverage in employee health insurance plans.
  2. Some States See New Insurers on Exchanges. Washington state's health insurance exchange is looking to be an attractive marketplace for ...

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I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic. However, when we think about death, we don’t just think about our own ...

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Dear Mr. Will, I read your recent column on the “supposed campus epidemic of rape, a.k.a. sexual assault” and am somewhat taken aback by your claim that forcing colleges to take a tougher stand on sexual assault somehow translates into a modern version of The Crucible that replaces witchcraft with rape hysteria. I was specifically moved to write to you because the rape scenario that you describe somewhat incredulously is not unfamiliar to me. ...

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In this Daily Show segment, "An Outbreak of Liberal Idiocy," correspondent Samantha Bee likens the anti-vaccine crowd to right-leaning climate deniers.  I've been saying this for awhile: The anti-vaccine mentality crosses party lines.  Remember, Jenny McCarthy got her start from the progressive-leaning Huffington Post.

While rotating through the local Veterans Affairs (VA) hospital during my residency in radiology, I noticed a curious phenomenon. When the weather was pleasant a large number of veterans would not show up for their scheduled CT scan or MRI. When the weather was miserable or dangerous the attendance would be maximum. We named this phenomenon the "VA paradox": a paradox because this is the opposite of what usually happens. After deeper ...

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Comedian John Oliver with a must-see takedown of Dr. Oz, after his disastrous performance at the recent Senate hearings: "It's easy to fill a show with shameless pandering without dangerously misleading medical information."  And at the 13:44 mark, he shows us how it's done.  Epic.

The California ballot initiative: Protecting patients or letting in a Trojan horse?A guest column by the American College of Physicians, exclusive to KevinMD.com. Physicians in California are mobilizing to oppose an initiative on the November ballot that will raise the cap on non-economic damages in medical malpractice cases. The current cap of $250,000 is part of California’s Medical Injury Compensation Reform Act, or MICRA. Adopted in ...

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

  1. FDA Finally OKs Inhaled Insulin. After several denials, the FDA announced Friday that it had approved inhaled insulin (Afrezza) to be used for improving glycemic control in adult patients with diabetes.
  2. ADHD Meds Tied to Cardio Risk. Danish children taking stimulant drugs for attention deficit-hyperactivity disorder (ADHD) had roughly ...

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It's a cold and rainy morning, and we've traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region. There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a ...

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If only our lives were more predictable and certain, we’d feel a greater sense of security and safety. Yet, much of what happens to us is beyond our ability to control. This is true whether we live in a third-world country or in the most advanced scientific and technological environment. It’s also true whether we’re struggling to make ends meet or living in the lap of luxury. No one is immune ...

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I’m 34 weeks pregnant and working hard to keep this baby inside me for as long as possible. As with my last pregnancy, there’s a real risk that the baby could come too early. But we’re both holding on so far, thanks to a combination of luck, modified bed rest and medical science. The science is my biggest concern right now. I will spare you much of it because, man or ...

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