Medical care in  America isn't doing so well when compared to other developed nations. Historically physicians did not want to take ownership of their  patients' problems. Patients have  free will. They can "choose" to be non-adherent. They can choose to not take the medication the doctor prescribes -- even if the one prescribed is $70 dollars a month when there is a $4 dollar Read more...

Do we treat diseases or symptoms in psychiatry?  While this question might sound philosophical in nature, it’s actually a very practical one in terms of treatment strategies we espouse, medications and other interventions we employ, and, of course, how we pay for mental health care. It’s also a question that lies at the heart of what psychiatry is all about. Anyone who has been ...

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When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess. I can't tell you the number of times I've been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to ...

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by Mariana Perroni, MD The following post was written on February 27, 2010, while working as a volunteer in a field hospital in Haiti. It was called Love a Child Recovery Center and it was run by us (Albert Einstein Hospital - São Paulo - Brazil), Harvard Medical School and University of Chicago Medical School. We ...

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Over the past few years I have talked with many hospitalists.   I know many hospitalist leaders and have many hard working hospitalists. Most classic general internists have viewed the hospitalist movement with skepticism.  Many outpatient internists express jealousy over the salaries and work hours of most hospitalists. But here is what most non-hospitalists do not understand.  In most hospitals in this country hospitalists ...

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"Code Blue ICU ... Code Blue ICU" I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace . The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried. As I walked through the sliding doors I passed the room ...

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When someone gets sick, what are their options? They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you're not sure if clinics can take care of everything, so you head to ...

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Recently I wrote a blog about how the American Academy of Pediatrics (AAP) thinks that otherwise healthy children with ear infections should wait a couple of days before starting antibiotics, because many will get better without them. Now there are two articles in the New England Journal of Medicine (here and here) saying that children with ear infections who are given antibiotics are more likely ...

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The Theresa Brown furor has got me thinking.  To be honest, I don’t think the doctor’s apparent offense was really that bad.  I remember giving and taking worse. When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition.  Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job.  But the ...

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by Paul Rousseau, MD Communication between physicians and patients is critical to quality care and improved outcomes, however, such discussions often seem labored and fraught with anxiety and stress. Physicians commonly speak too much and listen too little, while patients feel swept up in an unfamiliar and frightening situation with loss of control and little-to-no input into care. As I have ...

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