It’s hard to teach an old dog new tricks, but we can try. To write or to type, that is the question. To boldly go (according to the latest statistics) where only a small few are going; that is the challenge. Actually, for everyone in the medical profession, the reality of the paper chart is slowly coming to a close. The digital age is moving forward at lightning speed. But can you teach ...

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My wife and I were invited to dinner at the home of one of my daughter’s friends. My daughter is a graduate of the International Baccalaureate program of Murphy High and her friends tend to be interesting. This particular friend is majoring in pre-med and has parents who immigrated from Vietnam following the fall of Saigon. As is usual when one has a physician dinner guest (and perhaps when one doesn’t) ...

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by Krupali Tejura, MD A fellow physician called me with a consult this afternoon. He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn't show much better. A biopsy was done but the final results were ...

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An excerpt from White Coat, Black Hat. by Carl Elliott These days many thought leaders find themselves on shaky ground. The past few years have not been good for business. Some of the most prominent thought leaders have been exposed and censured by Grassley. Others have seen public opinion turning against them and gone underground. As more states institute Sunshine laws, anyone considering an industry ...

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POLST stands for "Physician Orders for Life-Sustaining Treatment". It is a next generation replacement for an Advanced Directive and DNR ("Do Not Resuscitate") order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting. The ...

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I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group--smart, efficient, motivated--and they scared the heck out of us medical students. I remember the day clearly: Not only was I on call, but I was assigned to the chief resident's team. I felt petrified. We'd started morning rounds ...

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An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc. My own education in pharmaceutical marketing began during my second year of residency at Massachusetts General Hospital. Suddenly, I noticed that Paxil bagels began appearing everywhere. I first saw them in the break room of the ...

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The regulators have completed their work. CMS has defined how you should use technology in your practice or hospital (Meaningful Use) and technical requirements for EHRs have been finalized. Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) have removed all ambiguity regarding Government financial assistance to those purchasing EHRs, and ONC certified EHRs will start appearing shortly. A national network of federally funded ...

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Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing. Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like ...

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Here are the top posts from this past week, based on the number of times they were viewed. 1. What to say to a person who is sick 2. Boston Medical Center gets screwed by the Massachusetts government 3. Can a pharmacy profit from gouging patients without insurance? 4. The story of vitamin D and its association with other diseases 5. Relationship advice for those dating American medical students

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient's description of her "rude and defiant" teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such difficulty. ...

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by Shawn Vuong Besides the fact that I am going to marry one, I want to say that nurses are the greatest ally to the medical student. "Nurses can make or break you."  I don't remember where I read this quote, so I do not know who to give the credit to, but the quote is true.  Nurses talk about doctors and medical students all of the time.  They ...

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An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives. by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions. All of this takes a toll.  Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions ...

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One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient. Clearly, a ...

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There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables. As anyone who has ever ...

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Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple ...

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"How many staffers should we have per doctor?" That's a question I'm asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond "it depends." One of the factors that needs to be considered is what jobs we're talking about -- clinical or front office. It's staffing in the clinical area that will do most to enhance a physician's productivity, so that's what we'll focus ...

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by John Rossheim IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information. Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems. These two stereotypes ...

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Answering a viewer question on tardy test result reporting, and a video preview of what's coming up this weekend on KevinMD.com.  I invite you to leave general medical and social questions in the comments for me to answer in future video previews. id="viddler_ca968274" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="430" height="370" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">

by James Gaulte, MD Should medical student applicants be chosen less for their demonstrated ability to master large amounts of knowledge and solve problems and more for their social consciousness and desire to push forward with social justice? That appears to be the suggestion of a panel of experts from the AMA in a project called the Initiative to Transform Medicine (ITM) who believe an ...

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