The medical field, more so than many other professional arenas, is continuously struggling to balance the concepts of increasing quality metrics, decreasing overall expenditure, and riding the crest of the current technological and scientific expansion wave. Within the past half century, our profession has borne witness to an explosion of advancement, and with this has come a contemporaneous increase in both the need for sub-specialization and, bluntly, the associated cost of ...

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A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist.  I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus. I expected a benign explanation for her swallowing issue.   She was relatively young and not particularly ill.  She had seen my partner years in the past for a similar complaint, which he ...

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In the last year and a half, I've been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I'm not actually vacationing. Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how ...

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I read with interest the recent article written by Dr. Rourke Stay, "What ESPN doesn’t tell you about MRI in professional athletes,” and couldn't agree more.  The bigger issue, however, is what ESPN may leave out of broadcasts about sports injuries.  Prominent figures on the air often espouse their knowledge with enough charisma to convince even the most doubting fan that their opinion is more than just an armchair ...

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Recently, Ohio became the 20th state to pass a law mandating that hospitals and clinics performing mammography screening to notify a patient in writing if results suggest something known as "dense breast tissue."   Standard mammography creates a 2-D image of breast tissue.  In general, this is sufficient for screening purposes.  However, especially in younger patients, the presence of dense breast parenchyma can lead to higher false negative readings and ...

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I'm no stranger to dealing with the medical world and its billing systems. I'm a triple cancer survivor, had knee surgery in 2012 and now have ulcerative colitis. All told, I've had eleven surgeries and fourteen colonoscopies. Paperwork is practically my middle name. But the last twenty-four hours have been ridiculous. In that time, I've had three different encounters with healthcare billing -- each absurd in its own way, and each more ...

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shutterstock_137251094 I have to admit, I’ve been excited to see radiology slowly infiltrate into the mainstream of sports.  Fifteen years ago, it was rare for the public to know when an athlete had an MRI. Now I hear people in the coffee shop saying: “Man did you see Derrick Rose go down last night?” “Yeah, we’ll just have to see what the MRI shows.” In ...

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We all accept that we can't vote until we are 18 and can't order alcohol -- at least legally -- until we are 21. We know that if we speed 60 mph in a 45 mph zone, we risk a traffic ticket or accident. We get used to these numbers and pretty much know the risks if we break them. However, the practice of medicine is becoming more and more ...

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shutterstock_97190261 In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough. There is little doubt that APCs ...

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To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known ...

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