The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today. A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and ...

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Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden. In this particular conversation, ...

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With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead. This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages. Response in the press has already raised issues with this, suggesting that this move would do little ...

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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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I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year.  She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty. Of note is that her symptoms seemed to start after a cruise.  I ...

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Bewildered, panicked, and disheartened. I watched my mother’s eyes dart back and forth as she read the pharmacy’s prescription cash price list, knowing she could not possibly dig deep enough in her faded purse to pay for her monthly medicines. In her early fifties, she did not qualify for Medicare, nor could we afford the COBRA payments that would extend coverage for our family since my father’s recent lay off. We ...

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Next in a series. The primary care physician (PCP) is the most broadly yet deeply focused care giver and as such is the the backbone of the healthcare system. But to do this work effectively requires time -- time which all too often is not adequately available. What constitutes primary care and who are the primary care physicians? They are the first responders, the first line of care, and very frequently ...

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Do you believe that I have to mention this?  I can’t believe it either but since the advent of the EMR, this seems to be an issue; a really big issue.  Amazingly enough, you are there, as a doctor, to treat the patient and not the computer.  You would think it was the other way around with all the bogus quality indicators, meaningful use baloney and pay-for-performance nonsense being stuffed ...

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This month, the literature and medicine group at my hospital met to discuss Arthur Miller's Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with "a shoeshine and a ...

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Should doctors grab a .health domain?So, you're setting up a website for your practice. You thought you'd just grab a .com, .net, or maybe .info. But now there's .health. Will one of those set you apart from the .com crowd? So what do you need to know about these new domains? 1. Will patients come looking for me on .health? The bottom line is that it's highly unlikely patients ...

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