Applying the anti vaccine mentality to car seats What if a big TV station came out with a blockbuster story claiming that infant car seats were implicated in cerebral palsy (CP)? After all, something like 99.7% of babies diagnosed with cerebral palsy had been brought home from the hospital in a car seat. In fact, every single time they went anywhere in a car, they were strapped into them. That’s ...

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I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back. Let me explain. A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing ...

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I had a silver-and-gold Passover. Hearkening back to the old Girl Scout song I learned from my mother:

Make new friends, but keep the old; One is silver and the other’s gold.
With no space or equipment to have a seder myself, I was nevertheless the lucky recipient of not just one, but two invitations. The gold was thanks to a quarter-century-plus friendship; the silver was from a family we met the week before ...

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Round and round and round we go yet again. The system is broken. Do something. Health care reform! “Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means -- and that everyone else agrees with them. Wrong. Quality is very much in the eye of the beholder, and ...

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I do not provide health care. What we physicians do is practice medicine, and what we do for patients is called medical care. No one says, “I want some health care.” What they think is, “I don’t feel well. I want to see a doctor.” People get sick and they get hurt. It’s true that many these conditions occur as a result of things they do (smoke, eat junk food, drink too much alcohol, ...

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The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends -- so he told me at every visit. His visits ...

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I just didn’t like the looks of him. It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in ...

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The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish. The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of ...

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"Do you mind telling your legions how long you intend to work?" Certainly. The short answer is, “Indefinitely.” The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts. First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my ...

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I am furious. For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don't do it at all. The United States Preventive Services Task force reviewed the literature and ...

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