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Is there really a physician shortage?

Or is it a declining number of doctors refusing the accept certain insurances, or subject themselves to the abuses of the health system?

Emergency physician WhiteCoat cites a number of stories where patients are not receiving timely access to care.

In one, which I alluded to last week, parents unable to find pediatricians in California willing to accept Medi-Cal. As he wryly observes, “the fact [is] that …

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Do doctors who use social media prescribe more medications?

Doctors are increasingly using social networking tools like Twitter, Facebook, and Sermo.

A recent study showed that 60 percent of doctors use, or are about to use, various Web 2.0 applications. That’s no surprise.

The unexpected finding was that physicians who reported they used social media prescribed 24 more medications each week when compared to their peers who reported that they did not.

So that begs …

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Tom Daschle withdraws, and how that will impact health care reform

There’s no shortage of informed opinions on the Tom Daschle debacle, and how this will affect the chances of successful health care reform.

I don’t pretend to be a political pundit, so instead, here is a collection of selected insights from news sites and health policy blogs that I regularly read.

First off, the NY Times says it will likely halt the momentum for health reform, and …

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Is depression more prevalent in medical students?

It appears so.

Chris Rangel points to a study showing that 21.2 percent of medical students (that’s more than 1 in 5), suffer from depression, compared to 10 percent in the general population.

Depression seems to hit its peak during the second year of medical school, and then gradually improves. In general, the rates of depression for students were generally higher than in residency.

Indeed, the …

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Remove a kidney through the vagina? Is natural orifice surgery the future?

For the first time, a living donor had her kidney removed through her vagina.

She was left with three small scars, with one hidden in her navel. There’s hope that the procedure, which reduces recovery time and is generally more tolerable than the traditional laparoscopic method, can encourage more people to donate.

Gynecologist Amy Tuteur takes a closer look at the procedure, and likens it to an …

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A shot of adrenaline, for asthma?

Cheap, generic albuterol inhalers for asthma are being phased out in favor of more expensive, more environmentally friendly, inhalers.

Patients, however, are bearing the brunt of the cost, with what used to cost less than $10 now costing several times more.

This country doctor relates a story of one his patients who injected himself with epinephrine for his asthma attacks. “When his asthma kicked …

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Can medical school expansion revitalize physician training?

We are in the midst of a golden age of medical education, with schools expanding at an unprecedented level.

MedPage Today reports from a recent summit of medical educators, where they concluded that, with nine medical schools set to open and the majority of the remaining 126 schools planning to expand class size, this is an “unparalleled opportunity” to reform physician training.

That time can’t come soon …

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How was Nadya Suleman impregnated with octuplets? Is IVF, the mother, or her doctors to blame?

Many have been asking me to comment on the recent octuplet case in the news.

I have to admit, this is out of my field, so I’ll point to a few other physicians who have been talking about the case.

When it was first reported, it was speculated that Ms. Suleman used fertility medications indiscriminately, and then had intercourse. Gynecologist Amy Tuteur suspected illicit use of …

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Doctors asking patients to pay more of their bill up front

As health care costs rise, more patients are switching to high-deductible insurance plans.

When that deductible hasn’t been met, doctors are becoming more aggressive in asking for their payment up front.

This move entirely makes sense, since like other businesses, physician practices are also wading through the difficult economic times.

According to the LA Times, 13 percent of a practice’s revenue comes from patients, and by becoming …

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Family murder-suicides, or, what drives a man to kill his own wife and children?

The economy is leading to a disturbing rise in family murder-suicide cases, with two high-profile cases in January.

And that’s just the beginning, according to sociologists.

“The economic situation also portends a significant increase in other forms of family violence, including spousal and child abuse, child neglect and other forms of dysfunctional behavior like substance abuse,” says sociology professor Sampson Blair at the University of Buffalo.

A …

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Can bedside manner be taught, or is it something you’re born with?

I’ve always thought that good bedside manner, like personality, is something you can’t learn.

So did Pauline Chen, but in her latest NY Times piece, she talks about a study that show us otherwise.

After an 18-month period where doctors met twice a month to practice skills designed to enhance compassion, or “reflected on their own work through discussion and narrative writing,” they outscored the controls …

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Cello scrotum, published in the BMJ, now revealed to be a hoax

The interesting journey of so-called “cello scrotum” has come to an end.

Inspired by “guitarist’s nipple,” which is a real disease caused by irritation caused to the breast from guitar playing, a doctor submitted the spoof 34-years ago to the British Medical Journal.

Described as “chafing of the scrotum when the instrument was placed between the cellist’s legs,” the author of the hoax decided to come …

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A concierge ER, or, can EMTALA-free, cash-only emergency departments save hospitals?

Given the financial trouble many ERs and hospitals are facing, concierge emergency care may be on the horizon.

Richard Winters (via GruntDoc) imagines such as scenario, which for a fee, patients receive private rooms, couches and chairs for family, private telephones and internet service, flat-screen television, and events to meet the hospital administration and physicians.

As long as every cent continues to be squeezed out of emergency …

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What’s the equivalent of 911 in Mumbai, India?

Most cities take emergency medical services for granted, but in Mumbai, they’re starting from scratch.

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How many babies can one woman carry?

That’s a question I was asked more than once, in light of this week’s story about the birth of octuplets.

For the answer, I’ll refer to this article in Slate. The largest reported number of fetuses in a single womb is 15.

The limit is not so much the number of fetuses, but the combined size and weight. As Christopher Beam explains, “once the total …

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Lost tampon? A doctor with tips and advice on what to do

Internist Doc Gurley confronts “the world’s most mysterious medical problem” with an educational video, complete with tips, advice, and a pulsing soundtrack.

Part 1:

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Part 2:

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(via ChronicBabe and Duncan Cross)

The lifelong effects of a concussion, can just one hit result in permanent damage?

Researchers are calling recent findings the tip of the iceberg.

MedPage Today
reports on a paper from Brain, showing that players who suffered a single concussion playing college-level sports had “greater declines in attention and memory and a slowing of some movements more than 30 years later compared with those who never had a concussion.”

The National Football League is currently conducting its own study, …

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Unable to provide proper patient care, emergency doctors are suing the state of California

Emergency physicians are forced to see every patient, and thus, are at the mercy of cutbacks in California’s Medi-Cal reimbursements.

Often times, they are paid at half the cost of treatment. With well-publicized stories of patients dying in the waiting rooms, or while waiting to see a physician, doctors are responding by suing the state for $100 million because additional funding is needed to maintain patient safety. …

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How the Office of the Inspector General is investigating end of life care

Imagine if you’re the attending on record in the ICU, and find that the federal government is investigating your care in end of life scenarios.

Pallimed discusses an article detailing that exact circumstance at a VA hospital.

Although they found no wrongdoing, they did find “significant variations with the interpretation of appropriate end of life management in the ICU, and recommended the establishment of new guidelines.”

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Will specialists sacrifice to pay primary care doctors? Are budget-neutral changes the only option?

Both the AMA and ACP advocate against budget-neutral solutions to fund primary care.

In an ideal world, that would be the optimal solution. But I don’t see it happening, especially with traditionally physician-antagonistic Democrats controlling Congress, and the fact that we’re in a recession.

Rather than start another specialist versus primary care battle, I simply want to acknowledge Bob Doherty’s point that budget-neutral changes that benefit …

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