From MedPage Today:

  1. Reaching Out to Smokers Boosts Quit Rates. Simply offering smoking cessation treatment proactively to all the smokers in a healthcare system meaningfully boosted the quit rate, a VA trial showed, while details emerged on provisions for coverage of such interventions in the Affordable Care Act (ACA).
  2. Lung Cancer Screening Versus Smoking Cessation? When the Medicare advisory panel voted against covering lung ...

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From MedPage Today:

  1. The 5 Big Surprises in Code Denials. An April 30th post on the Physicians Practice website, "5 Common Medical Practice Denials and Remedies: March 2014" has a nifty info-graphic which synthesizes Centers for Medicare and Medicaid Services (CMS) data from the month of March in 2014.
  2. Treat Car Crash Pain Early On, Lest It Linger. Widespread pain that persists a year ...

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After every mass murder, the question everyone asks is why it happened. How could anyone possibly be so violent, or so evil, or so out of control, or so crazy as to engage in the wholesale and indiscriminate killing of a bunch of people who are usually complete strangers? In some cases, there are longstanding preexisting warning signs: a history of mental illness, substance use, isolation and/or estrangement; the repeated experience ...

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A few years ago I wrote that uncertainty is inevitable in psychiatry.  We literally don’t know the pathogenesis of any psychiatric disorder.  Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric.  Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric conditions went to neurology; brain tumors and hemorrhages went to neurosurgery; and so forth. This leaves psychiatry ...

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This article is making the rounds among physicians on Twitter. Much of the information in the article, unfortunately, is accurate. For some of the reasons stated there, I left the “traditional” health care system and pursued work at the “fringe.” Part of this is due to my clinical interests: I like working at the intersections of different fields. For example, I like the intersection of psychiatry and hospital medicine, which is called 
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Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered. And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by "experts" brim full with diagnostic exuberance -- sometimes well meaning, sometimes influenced by extensive drug company affiliations -- and always ungoverned by simple common sense, a respect for ...

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In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve.  Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but -- in general -- we still have a long way to go in our attitudes toward mental illness. I think it’s ...

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From MedPage Today:

  1. Small Practices: Down but Not Out. Emily Briggs, MD, MPH, is all too familiar with the decline in small physician practices.
  2. IV Ketamine Rapidly Effective in PTSD. Patients with moderate to severe post-traumatic stress disorder (PTSD) symptoms showed rapid and substantial relief with a single intravenous dose of ketamine in a pilot randomized trial.
  3. Missed Doses Cripple Postop DVT ...

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From MedPage Today:

  1. USPSTF Praised for Preeclampsia Guidance. When it comes to whether or not to treat women at high risk for preeclampsia with low-dose aspirin therapy, the U.S. Preventive Services Task Force (USPSTF) guidelines are spot on.
  2. Early Signs of Stroke Missed in Many Cases. Many strokes may be missed in emergency departments (EDs) in the days before the problems become obvious.

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Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave.  This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad.  The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in ...

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