Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice. With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day ...

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Last night, I responded to a code blue while working the night float at the hospital. The patient was a relatively young female who had just completed a coronary artery bypass procedure. Per training, I began compressing her chest to induce blood flow to the rest of her body. As I pushed, the incision reopened and blood began spewing everywhere. I could feel her ribs giving and cracking from the force ...

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I nearly died a month ago on a treadmill halfway through a stress test. The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours ...

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First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment.  Risk is an interesting word, because risk is about populations; it loses the individual. And it seems that statin treatment has taken on a bit of stigma -- something we’re used to in psychiatry -- now you can eat your cake and have low cholesterol, ...

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I rather doubt you need me to bring the roiling statin debate to your attention, given its prominence in scientific circles and mass media alike. In essence, a new set of guidelines for the use of lipid-lowering drugs to prevent heart disease was issued with considerable fanfare and then set off a firestorm of controversy. The old approach relied heavily on levels of LDL cholesterol, while the new approach ...

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From MedPage Today:

  1. OTC Thyroid 'Boosters' May Harm. Patients who take over-the-counter supplements that promise to enhance thyroid function may get more than they bargained for.
  2. 10 Questions: Sanjay Gupta, MD. What is the best way to avoid burnout? Slow down and listen to your patients, says Sanjay Gupta, MD. That's his answer to just one of the 10 Questions the MedPage Today staff ...

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From MedPage Today:

  1. Breast Cancer: Adding Avastin Boosts Toxicity. Beleaguered bevacizumab (Avastin) has failed another test in breast cancer.
  2. FDA Wants Proof of Anti-Bacterial Soap Claims. Manufacturers of nonprescription anti-bacterial hand soaps and body washes will soon be required to show their products are safe for long-term daily use and are more effective than plain soap in stopping the spread of infections.

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A version of column was published in USA Today on November 20, 2013. I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin.   When I saw him months later for follow-up, he admitted that he didn’t fill the prescription. “I took red yeast rice capsules instead,” he said. When I asked him why, he told me that he was wary of statins’ long list of side effects ...

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New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines ...

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Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied to medicine as well. Having just turned 65, my financial advisor says from his analysis, I can retire any time now. I have a contract with my cardiology group, which ...

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