It is so nice to be right. To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they'll get an accurate diagnosis. A recent study validates that opinion. MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries ...

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Recently, a family physician colleague asked me to explain why the Affordable Care Act requires private health insurers to provide first-dollar coverage for preventive services that the U.S. Preventive Services Task Force assigns an "A" or "B" (recommended) rating, but allows public insurers (Medicare and Medicaid) to determine if and how they will cover these services. Until recently, the question hadn't come up, since Medicare has agreed to cover pretty ...

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Why doesnt everyone have a pocket ultrasound machine? For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, ...

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Having worked with radiologists a lot, I have great respect for their specialty. The job is indeed a very difficult one. Without seeing the patient (the most difficult part of what they do), they have to thoroughly comb through every image put in front of their eyes and give us their assessment of what’s abnormal and what’s not. Their interpretation will be one that other doctors will hang their hats ...

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Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption. During my time abroad, I watched several patients with heart attacks pass ...

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A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education. Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier? Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate ...

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A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after years of observing his housestaff. As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who ...

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Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades. Robert E. Tarone at the National Cancer Institute (who isn't a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography ...

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Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos. The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are ...

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From MedPage Today:

  1. Preop PET Cuts Lung Cancer Surgery. Routine preoperative PET imaging led to a significant reduction in unnecessary surgery for non-small cell lung cancer (NSCLC).
  2. A Cure for Chlamydia Arthritis? Increased understanding of the biology and survival tactics of Chlamydia trachomatis is suggesting that the post-infectious chronic arthritis experienced by many patients may actually be curable.
  3. Efavirenz Tops Lopinavir in ...

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