When I meet a new patient, I’m frequently astounded by the health care he has received. I’ve met patients with absolutely no cardiac symptoms who have been receiving EKGs every six months for years. I’ve had patients brag to me about their annual executive physicals in which myriad tests including treadmill stress tests and chest x-rays were routinely performed. Patients get head-to-toe CT scans under the mistaken hope that they ...

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This is why doctors practice cover your ass medicine A small case with big implications almost escaped my notice recently  The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection. According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains.  OK, stop right there ...

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From MedPage Today:

  1. Docs Unprepared for Payment Reform. A pair of recent reports call into question the ability of physician practices to embrace health reform efforts.
  2. Even a Few Drinks Tied to Poor Birth Outcomes. Women who consumed low levels of alcohol before conception and during pregnancy were more likely to have adverse birth outcomes such as low birth centile, low birth weight, and ...

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When it comes to high blood pressure treatment in the elderly, the plot continues to thicken. Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+. And now this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication ...

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From MedPage Today:

  1. All-Oral HCV Regimen Works in 9 Out of 10. An all-oral, 12-week regimen appears to successfully treat hepatitis C virus (HCV) infection in about 90% of patients.
  2. CDC's Frieden to Docs: Dial Back Antibiotic Rx. Doctors in some hospitals are prescribing three times more antibiotics than physicians treating similar patients in other institutions.
  3. Anger Is Fast Trigger for Heart ...

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From MedPage Today:

  1. Bariatric Surgery Beneficial in Type 1 Diabetes. Overweight patients with type 1 diabetes may make good candidates for bariatric surgery, but unlike with type 2 disease, the procedure doesn't offer a chance of remission.
  2. Young Adults Undertreated for High BP. Primary care physicians may be dropping the ball on getting young adults with hypertension the medication they need to control their ...

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From MedPage Today:

  1. Medicare Will Cover Rehab for CHF Patients. Medicare will cover cardiac rehabilitation services for patients with stable yet chronic heart failure.
  2. Long-Acting GLP-1: The Key to Adherence? The thinking behind long-acting GLP-1 agonists has been that fewer injections should translate to better outcomes -- particularly, better glycemic control -- because diabetic patients should be more compliant if they have to inject ...

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Uncle Walt died this morning. Finally. I say "finally" because I believed this day would come four months ago, when he had emergency bypass surgery. At the time, I didn't believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, "With bypass surgery, you might live. Without it, you'll be dead before the weekend is over." Walt's ...

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Ms. Smith (name changed) is 82-years-old, but currently looks about a hundred. I met her, intubated, in the ICU two weeks ago. She lived alone, hadn't told family she wasn't feeling well, but had called 911. In the emergency department, she was struggling to breath, and was intubated, having gone into respiratory failure. She was found to have a severe pneumonia affecting the majority of both her lungs. She also went ...

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Recently, CVS Caremark announced that starting October 1, they will no longer be selling tobacco products, including cigarettes, in their CVS stores. Taking a bold and unexpected stance on the issue, CVS’s CEO Larry Merlo reasoned to ABC News that “We’ve come to the conclusion that cigarettes have no place in a setting where health care is being delivered.” What does he mean by that? Here, he is referring to ...

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