“Do not get caught” seems to be the real rule of the law in South Florida, where I live. I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items. The Joint Commission, ...

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My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined. At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams ...

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One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed. I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and ...

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As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues: “Should I be resuscitated if my heart stops and I stop breathing?" “Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?” “Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?” “When should we refuse tests for ...

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A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure.  There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it ...

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My 66-year-old professional athletic patient had a history of a scar tissue related small bowel obstruction seven years ago related to a previous appendectomy. He now had similar symptoms with cramping, lower abdominal pain, and some nausea. Since his office was next door to his longtime friend and gastroenterologist, he called over there. He was given an appointment with the junior partner since his buddy was out of town. Thirty years ...

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shutterstock_175968083 I care for a 65-year-old woman suffering from sarcoidosis affecting her lungs, her skin, her bones, her nerves, her blood chemistries, her kidneys, her colon and her mind. She has gone from an active spouse, mother, grandmother, tearing up the dance floors with her husband, to a home recluse calling friends to drive her to medical and care appointments while ambulating with ...

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shutterstock_31681267 On Monday March 30, 2015 our Greenway PrimeSuite electronic health record had a system-wide failure at the level of the Edgemed Computer service center in New York State. It meant that I was back to using pencil and paper to interview patients and record the answers and physical findings. With much trepidation, I began seeing patients with two sheets of white blank ...

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I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant. The telephone rang with the caller ID identifying a call on my office work line. “Hello this is the emergency department, please hold on for Dr. S.” ...

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Once again government regulators have put in place well-meaning rules without anticipating the consequences. We all hate sitting around in the emergency department waiting to be seen and to be treated. On October 15, 2014 as part of the new Affordable Health Care Act and the patient satisfaction portion, hospital ERs will have about 180 minutes from the time you arrive and sign in to evaluate you , treat you ...

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