One of the biggest changes to health care over the last 20 years has been the corporatization of medicine, from small independent physician practices, to large corporations that now run the show. Medicine has gone from good old Dr. Johnson’s office around the corner, to a world of boardrooms, megamergers and takeovers. This has enormous downstream effects -- not least to the way physicians practice medicine and their ...

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There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using ...

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Spot the word "first" in a headline, and you might assume a major milestone has been reached. Think first person on the moon, first woman on the Supreme Court. But in health care news, things heralded for being first might not amount to a clear advance for patients. Take two recent FDA announcements that made a splash despite weak evidence that they really help people. In March the FDA announced its approval of a “first treatment ...

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It seems now as if every day and every month is associated with a "national day" or an "awareness month."  Some such as "national taco day" may be less important than others, well depending on one's priorities.  Although many illnesses now also have a dedicated day or month, many of these diseases will go unnoticed.  They will rarely be discussed -- that is until a celebrity or someone in the ...

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Geographical arbitrage is a huge component to being able to build wealth in a timely manner.  For doctors, the formula for rapid wealth accumulation calls for geographical arbitrage even more strongly as our salaries do not have wide ranges across the country.  A doctor in Texas will probably command a similar salary in Arizona (maybe slightly less).  A doctor in the midwest might earn more, spend less, and work less ...

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I was asked to present information about mental health to a lay audience. This is both an exciting and daunting task. I imagine it’s like asking someone to talk about fish. There are so many kinds of fish! They live in many habitats! Some of them look more like snakes than fish! There are so many directions to go. I have given a “psychiatry 101” talk to many non-clinical audiences in ...

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When you think about the future of health care, what word comes to mind? How about the word, "female"? If it didn't come to mind, it should because the landscape of the medical field is changing. As a result of that change, it is more essential than ever for women physicians to take control of their finances. Whether you're just entering the field or you've been practicing medicine for years as ...

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If you’re sexy, fit and nimble, if you can part your thighs and bend your knees, if you can see your private parts without a mirror, ignore this. Move on. This is not for you. This is for those with flailing sex-drive and failing abilities whose sex life is a challenge, but they’d like to make their partners happy and have some fun. Maybe your parents or grandparents. This must be an ...

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I’m sitting on a cross-country flight to California with utmost respect for the professionalism of the crew, especially considering my life will be in their hands for the next 6 hours. Despite understanding the physics, I am still amazed by flight, and even more so by the coordination required to manage the logistics of shuttling so many people and their luggage around the world. As health care leaders apply a business ...

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While the vast majority of measles cases in the U.S. and worldwide are occurring in unvaccinated children, a fair percentage is also occurring in adults.  With more-widespread transmission of measles, it’s becoming more important for all of us – yes, that includes parents – to make sure we’re well-protected. Measles is probably the single most contagious infection that humans face. The key to preventing the return of widespread measles is in ...

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A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties are divided up. If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the ...

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A lot of parents ask me, about the HPV vaccine, "Isn't that the optional one?" Well, let me walk you through why my answer to that question is a hard "no." Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains ...

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If you live or work in Washington DC, your number one health care question is how do I (or my meal ticket people) win the next election. If you live or work in Caruthersville MO, chances are that your most pressing health care question is how do I (or my immediate family members) get a hold of some insulin this month. Theoretically speaking, in a healthy democracy, the answers to ...

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“Does my insurance cover this?” I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I -- a gastroenterologist -- do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues. Of course, patients assume that we physicians have an expansive ...

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In medical school, you’re not taught how to give stellar patient presentations. Yes, you’re shown the traditional order of things: “Give an effective one-liner first, then tell the HPI [history of present illness] but only give pertinent info, etc.” Just exactly how to deliver the punch that impresses your attending is an art. And it’s an art that takes some time to perfect. My very first time presenting a patient was ...

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An excerpt from Private Equity in Gastroenterology: Navigating the Next Wave. A long time ago, gastroenterologists ran solo or small group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered. But over the years, everything got too complicated. From insurance reimbursements to ...

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For as long as I remember, studying medicine has always been the goal I focused on the most. For years, I thought that I knew the path I was taking, and that I calculated the benefits and drawbacks. However, with time, I learned that no matter how much one assesses his decisions, one cannot have a full grasp of it, until he/she “begins” to experience it. I wasn’t aware how much ...

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As my patients aged along with me, I noticed both the expected increased numbers of people with some form of dementia and even more patients who were worried about this topic. Unless you have been away on a ten-year safari, you are very aware that dementia is a growing problem. Some 5.8 million Americans are living with Alzheimer's disease, and similar numbers occur in most western countries. The incidence goes ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir. On physical examination, the patient is afebrile, and blood pressure is 126/74 mm ...

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When writing medical notes, some clinicians include an appreciation of their patient's personality and disposition in their opening line (the "chief complaint"), or when they're wrapping up (in the "assessment and plan"), or in both locations. You know — it goes like this: "CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …" or: "A/P:  To summarize, Mr. Jones is a delightful 89-year-old man presenting with …" or: "CC:  This lovely 74-year-old retired school teacher was in her usual state of health ...

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