I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion).  I argued vociferously against it.  However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway.  To our surprise and dismay, it came ...

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Here are the three most useful words for a doctor: "I don’t know." A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes. Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical ...

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I’m a big game theory guy. I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the "players" almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is ...

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by Alex Smith, MD I used to get Sports Illustrated, and my favorite column was titled, "This week's sign that the apocalypse Is upon us."  Well, JAMA recently published the medical equivalent. Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA ...

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To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative. Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times as ...

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I love running. I typically run 3-4 miles a day 5 to 6 days per week. It's only about a half hour of time, and it's well worth it. I get 'in the zone' when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It's helped me immensely to stave off the obesity issues that have ...

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Part one of the three-part series, Let's Pay Popular People More! My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of ...

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by George H. Northrup, PhD No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards. With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties.  Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress.   Money has typically been a ...

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Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers.   Private practices are almost exclusively for-profit.  Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments. Hospitals can be for-profit, not-for-profit ...

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There’s been a movement afoot for several years now to quantify pain as the so-called "Fifth Vital Sign." It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word "sign" has a specific meaning in ...

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