Whether they are young or old, we do not want our loved ones to die.  Period.  Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void.  I completely understand. But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm.  You see, ...

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I click open the x-ray viewer.  After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam.  Yet I audibly gasp as the chest x-ray loads.  The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes.  I begin to count the fractured ribs -- 1, ...

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I can’t tell you that the “patient satisfaction obsession” is suddenly going to focus on patient health over profits and start being applied fairly to doctors and nurses. I can’t tell you that someday politicians, administrators and insurance companies will wake up and see things the way you and I do. I can’t tell you that someday, all the demands for inappropriate medications, tests and treatments will end. I can’t tell you that ...

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On a recent cross-country flight, I feigned sleep and overheard the following conversation between my seatmates: a radiation oncologist (I'll call her "Dr. M"), and a former firefighter/paramedic called, "Captain." Thought you'd like to listen in. DR. M: You guys have been my heroes for a long time, the way you constantly put your lives on the line. CAPTAIN: We're in serious danger 10% of the time, at most. Moderate danger another ...

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When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me. Many ...

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When I patronize a restaurant, I am fully aware that the restaurant staff's goal is to serve me quickly and efficiently with few (or no) mistakes.  Regardless of how ravishingly starved I feel, my severe hunger pangs do not propel me to the front of the line, nor do they make me more of a priority than another customer, no matter how much I moan and cry in agony.  If ...

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I recently treated what looked like one of those unnecessary patients in one of our emergency departments. You know the ones. The ones that don’t need to be there because they should have gone somewhere else to receive care. She was a 28-year-old woman who presented with lower abdominal pain. Her pain started abruptly in her left lower abdomen. She had no nausea or vomiting or fever. After my evaluation and ...

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From MedPage Today:

  1. Density of CAC Has Role in Heart Risk. The density of calcium in coronary artery plaque is inversely and significantly associated with heart disease and stroke risk independent of calcium volume and should be considered whenever calcium scanning is used to assess patient risk.
  2. Exercise Delays Need for New Hips in OA. A program of exercise therapy helped patients with hip ...

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Recently, I received a phone call in the late afternoon from someone very close to me. Please note that this someone is also a doctor. “Uh, I need you for a minute. I’m kind of freaking out. Can I talk to you?” She had just gone to her local optometrist to get a new prescription for glasses. The optometrist looked in her eyes, told her that both of her optic nerves ...

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If you had to pick a single metric to a measure a hospital, which would you choose? Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing ...

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