"If a tree falls in a forest and no one is around to hear it, does it make a sound?" Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn't know what's ...

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Most hospitals are strapped with a massive amount of debt.  Not monetary debt, but sleep debt.   Amongst both the staff and patients, sleep is severely lacking.  In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day.  But sleep isn’t a luxury.  Rather, it’s a medical necessity. Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood ...

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Over the last year I’ve become rather addicted to golf. Having always been more into cardiovascular sports I’m actually quite surprised with how much I’ve taken to it. Fresh air, outdoors, lots of walking in beautiful nature and spending time with friends -- what is there not to like? Anyway, I’ve frequented several different courses in the Boston area in just the last few months. Last week, we were due to ...

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Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

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Top stories in health and medicine, August 19, 2014From MedPage Today:

  1. Hospitals Question Charity for Some Patients. As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn't.
  2. Antibiotics Early in Life May Boost Obesity Risk. Exposure to antibiotics ...

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I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes. Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA). But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can't always ...

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We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few ...

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Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me. I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn't get written for her care by the admitting physician. ...

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10 potential benefits of robot caregivers My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy. I have to admit that my own first reaction to the topic was captured in the Times' letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … ...

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No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving ...

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