I have received several phone calls in the last few weeks from young adults requesting information about their last vaccinations. They are traveling to areas of the world that suggest or require certain vaccines and do not remember if they had them or not. Others are applying for positions of employment which require travel and the employer’s human resources department needs the patient’s updated vaccination records. When we tell them that ...

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For the last 25 years, I have had the privilege of being a designated airman medical examiner by the Federal Aviation Administration. To earn that privilege, it required flying to FAA headquarters and taking a one-week training course followed by refresher training material every three years. The FAA grades medical examiners annually by our judgment and decision-making. The nature of the questions we are required to ask the pilot candidates, and ...

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Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get ...

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We have a new electronic medical health record system at our hospital. It was introduced with what I believe is a short and ineffective training program for physicians followed by a far too short on-location use of experts to help the doctors and nurses learn the new system. It is frankly a pain in the neck to access the computer from outside the hospital due to the multiple layers of ...

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I practiced general internal medicine from June 1979 until November 2003. Immediately after training, I became an employed physician of an older internist covering my employer’s patients and building my practice for two years before embarking on my own. I saw 20 or more patients per day in addition to providing hospital care and visiting patients as they recovered in nursing homes. As managed care made its clout felt by kidnapping ...

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My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader. Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a ...

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A study published recently in JAMA Internal Medicine looked at 650,651 Medicare patients hospitalized in 2013. It showed that when patients were cared for by their own outpatient physician, they had a slightly better outcome than when the patients were attended to by full-time hospital-based specialists who had not previously known them. As an internal medicine physician who maintains hospital privileges, as well as caring for patients in ...

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As an internist with “added qualifications in geriatric medicine” I care for a great many elder individuals. In most cases, these are individuals I met 20 or more years ago and have been privileged to share their lives with them as they aged. The circle of life is relentless and unforgiving, so there comes a time when these relationships end. In some cases, it comes when they can no longer care ...

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My spry, 90-year-old patient decided she had a urinary tract infection two weeks ago. She had difficulty urinating and the constant urge to void with no fever, no chills, no back pain, no bloody urine. She was advised to come in for an appointment the same morning, but this didn’t suit her. The alternative choice was to see her urologist who made time available that same day. She decided this ...

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“Do not get caught” seems to be the real rule of the law in South Florida, where I live. I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items. The Joint Commission, ...

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