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4 lessons every woman doctor must learn
Recently, I wanted to find some inspirational articles for female doctors. This letter to the young female physician by Dr. Suzanne Koven was one of the first things I came across. I wish someone had written me a letter when I was young and dumb and entering internship. Maybe it would have been a good warning. I mean, I was clueless about what lay ahead. I might have had an inkling about the ambivalence I would feel about what now is known as “work-life balance,” though I called it “lifestyle” back in the day, and it was less about children and more about sleeping in and staying out. But I had no id...
Source: Kevin, M.D. - Medical Weblog - February 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/sasha-retana" rel="tag" > Sasha Retana, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

Study finds alcohol use the biggest risk factor for dementia
This study looked specifically at the effect of alcohol use disorders, and included people who had been diagnosed with mental and behavioural disorders or chronic diseases that were attributable to chronic harmful use of alcohol.Of the 57,000 cases of early-onset dementia (before the age of 65), the majority (57%) were related to chronic heavy drinking.What is the Difference Between Alzheimer ’s and DementiaSubscribe to the Alzheimer's Reading - This is a Free Service - Join NowLargest study of its kind finds alcohol use biggest risk factor for dementiaOf the 57,000 cases of early-onset dementia (before the age of 65...
Source: Alzheimer's Reading Room, The - February 23, 2018 Category: Neurology Tags: alcohol dementia alcohol disorder Alzheimers Dementia chocoholic abuse chronic alcohol abuse dementia care dementia risk early onset dementia Source Type: blogs

The CVS-Aetna merger is still the one to watch in 2018
Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December. CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise — a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company generated $177.5 billion in net revenue in 2016. With its purchase of Aetna, another bold company and the nation’s third-largest health plan, C...
Source: Kevin, M.D. - Medical Weblog - February 22, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/leah-binder" rel="tag" > Leah Binder < /a > Tags: Policy Hospital-Based Medicine Public Health & Source Type: blogs

Present Medical Practice is Not Configured to Manage a Future of Ever-Improving Rejuvenation Therapies
The present day organization of medical practice and its regulation is built atop the infectious disease model, even where it engages with age-related diseases. Prevention is a comparatively thin thread in an industry largely focused on the strategy of waiting until there is a problem, then attacking the symptoms of that problem with every available tool, as aggressively as possible. This isn't all that useful for age-related disease to start with, but it simply doesn't work for a world in which rejuvenation therapies that can repair the damage that causes aging initially arrive in a prototype form and then grow more capab...
Source: Fight Aging! - February 22, 2018 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Senate HELP Committee Holds Hearing on Opioids and the Impact on Families
Conclusion In a moment of rare bipartisanship, Committee members came together to agree that additional funding was needed to address the opioid crisis and provide opioid use disorder (OUD) sufferers with adequate anti-addiction resources. The bipartisanship ended, however, Democrats specifically criticized recent budget cuts by the administration and recommended that additional federal funding should be directed towards Medicaid and other health care institutions that work to support the families of opioid users.        Related StoriesHouse Holds Hearing on Opioid CrisisState of the ...
Source: Policy and Medicine - February 22, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Medicine needs its soul back
In a recent issue of the Annals of Internal Medicine, Terwiesch and colleagues propose “reimagining provider visits as the new tertiary care.” Initially, their arguments seem sound, even reasonable. Then, they conclude with this: The conceptual change is to see every engagement with a clinician not as something to be celebrated but as a kind of failure — an inability to accommodate patient needs by any of the less expensive technology-enabled levels of support. In this vision, provider visits, including those of primary care practitioners, become the new tertiary care. With technology both facilitating an...
Source: Kevin, M.D. - Medical Weblog - February 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/robert-baker" rel="tag" > Robert Baker, MD < /a > Tags: Physician Hospital-Based Medicine Source Type: blogs

The biggest innovation in health is here. And you ’re probably using it.
Health care is obsessed with new technology. Every week, a new article comes out promising disruption of medical care as we know it through personalized genetic therapy, app extensions that transform smartphones into ultrasounds or autonomous surgical robots. Yet, one of the best examples of health care technologies is also one of its oldest — instant messaging. Though the original messaging platform AOL Instant Messenger was sadly discontinued at the end of 2017, it birthed many other programs that are now used in a variety of sectors, particularly within the Veterans Health Administration. Providers at any VA can m...
Source: Kevin, M.D. - Medical Weblog - February 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/eunice-zhang" rel="tag" > Eunice Zhang, MD < /a > Tags: Tech Mobile health Primary Care Source Type: blogs

How telemedicine will revolutionize primary care
It has become more and more evident with time that the health care delivery system here in the United States is riddled with issues. One with many disagreements arising from the fact that there is no clear and universally acceptable solution to our problems. In many ways, the system seems to step on its own feet — as the health care professionals working within it fight to make it work the way it is intended or find themselves at odds with their own professional principles. This dysfunction amounts to what Dr. Atul Gawande calls a “giant conundrum.” Much to our chagrin, the shortcomings of our system are ...
Source: Kevin, M.D. - Medical Weblog - February 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/ashten-duncan" rel="tag" > Ashten Duncan < /a > Tags: Tech Mobile health Primary Care Source Type: blogs

The miscalculated fear of an opioid crisis in Haiti
Opioids are an essential class of drugs used in pain management. In recent years, complex mechanisms pertaining to their abusive use have prompted a deadly crisis which is unfolding in the United States. The U.S. Centers for Disease Control and Prevention stated that 91 Americans lose their lives daily due to an overdose of opioid drugs. This public health crisis has inspired much apprehension even among Haitian diaspora in the United States. Although needed painkillers are notably lacking in developing countries, the fear of a similar path has led a high-profile personality to advise against their use in Haiti. Indeed, he...
Source: Kevin, M.D. - Medical Weblog - February 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kenny-moise" rel="tag" > Kenny Moise, MD < /a > Tags: Policy Pain Management Primary Care Source Type: blogs

A physician goes from stressed to zen
I did not need help. I could do it myself. I never asked, and anyone who worked with me quickly understood they did not need to offer. This was my modus operandi. It was how I unconsciously organized my life, no more aware than riding a bike or tying my shoes. It happened in the background — utterly unknown to me for many, many years. I could see “side effects” of this unconscious pattern, the importance of self-sufficiency and doing everything on my own. I relished the ability to do what others were doing and then do just a little more. This brought me a sense of pride and a sense of satisfaction. I enjo...
Source: Kevin, M.D. - Medical Weblog - February 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/gil-c-grimes" rel="tag" > Gil C. Grimes, MD < /a > Tags: Physician Primary Care Psychiatry Source Type: blogs

CMS Quietly Launches an Offensive Against Direct Primary Care
By NIRAN AL-AGBA, MD Our healthcare system is self-destructing, a fact made more obvious every single day.  A few years ago, a number of brave physicians who were fed up with administrative burden, burnout, and obstacles to providing care for patients started a movement –known as Direct Primary Care (DPC.)  This is an innovative practice model where the payment arrangement is directly between a patient and their physician, leaving third parties, such as insurance or government agencies, completely out of the equation.  The rapidly growing number of DPC physicians have organized into a group called the ...
Source: The Health Care Blog - February 19, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized CMS direct primary care Medicare value-based care Source Type: blogs

Is there a way to make primary care sexy?
When I started medical school over four and a half years ago (I took a research year), I knew that primary care was my passion. I actually had a dream beyond medicine to be a liaison of sorts between the ivory tower of medicine and the community. Once I stepped onto the scene of my medical school, things started to change. My goals stayed the same, but I started to have a thought that I hadn’t considered prior to medical school: Could I afford to be a primary care physician? Relax. I’m not talking money; I’m talking patience. Patience, not patients. I didn’t have a problem explaining diabetes for 27...
Source: Kevin, M.D. - Medical Weblog - February 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jennifer-udom" rel="tag" > Jennifer Udom < /a > Tags: Education Primary Care Source Type: blogs

Trump Administration Releases Budget Proposal
The Trump Administration recently released its fiscal year (FY) 2019 budget proposal, including extensive health policy provisions. The budget proposal features numerous program integrity provisions. For instance, the budget calls for: a $45 million increase in Health Care Fraud and Abuse Control funding; expanded prior authorization requirements for high utilization practitioners of radiation therapy, therapy services, advanced imaging, and anatomic pathology services; expansion of the items of DME, prosthetics and orthotics that are subject to prior authorization; a demonstration to test the use of a benefits manager fo...
Source: Policy and Medicine - February 19, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Trump Administration Releases Budget Proposal Calls for Increased Funding for Fighting Fraud and Abuse
The Trump Administration recently released its fiscal year (FY) 2019 budget proposal, including extensive health policy provisions. The budget proposal features numerous program integrity provisions. For instance, the budget calls for: a $45 million increase in Health Care Fraud and Abuse Control funding; expanded prior authorization requirements for high utilization practitioners of radiation therapy, therapy services, advanced imaging, and anatomic pathology services; expansion of the items of DME, prosthetics and orthotics that are subject to prior authorization; a demonstration to test the use of a benefits manager fo...
Source: Policy and Medicine - February 19, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Trump Administration Releases Budget Proposal Calls for Changes to Open Payments and Increased Funding for Fighting Fraud and Abuse
The Trump Administration recently released its fiscal year (FY) 2019 budget proposal, including extensive health policy provisions. The budget proposal features numerous program integrity provisions. For instance, the budget calls for: a $45 million increase in Health Care Fraud and Abuse Control funding; expanded prior authorization requirements for high utilization practitioners of radiation therapy, therapy services, advanced imaging, and anatomic pathology services; expansion of the items of DME, prosthetics and orthotics that are subject to prior authorization; a demonstration to test the use of a benefits manager fo...
Source: Policy and Medicine - February 19, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

How to get back into the medical workforce if you ’re a mom
As women in the medical workforce increase, women physicians are faced with the unique position of training the hardest they ever had in their lifetime cutting into precious childbearing years. Many women physicians seek time off or engage in part-time jobs to address the dilemma of fulfilling the obligations of their careers while enjoying the tender years of their babies. Others pursue non-clinical routes such as medical chart reviews or telemedicine jobs imparting advice online for a baby-friendly schedule. They are reminded ad nauseum that these are years they will never regain. How does a physician mother enjoy her ch...
Source: Kevin, M.D. - Medical Weblog - February 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/virginia-thornley" rel="tag" > Virginia Thornley, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

What ’s our goal with opioid treatment?
When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids but were unable to tolerate severe cravings in addition to withdrawal. Getting off opioids seemed impossible. Instead of being part of the solution, I felt like I ...
Source: Kevin, M.D. - Medical Weblog - February 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs

The challenge of the worried well
A guest column by the American College of Physicians, exclusive to KevinMD.com. I recently saw a 35-year-old patient of mine who came into clinic requesting brain imaging. Although she had no specific symptoms, she had a friend who was diagnosed with a brain tumor several months ago and is concerned about the possibility that she could have one as well. When asked why she thinks she might have a brain tumor despite having no real symptoms, she replied that her friend also had minimal or at most subtle symptoms until her tumor was discovered at an advanced stage. She has read about the clinical manifestations of brain tumor...
Source: Kevin, M.D. - Medical Weblog - February 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/philip-a-masters" rel="tag" > Philip A. Masters, MD < /a > Tags: Physician American College of Physicians Primary Care Source Type: blogs

Turning doctors into technicians is a mistake
During our lifetimes, the role of physician has been shrinking, from healer to technician. You’ve probably seen the famous painting, Doctor and the Doll, done by Norman Rockwell in 1929. It depicts an old country doc listening with his stethoscope to the heart of a doll held up to him by a worried little girl. Today there’s no time for such play, and no pay for it, either. The gradual transformation of health care from a service to an industry has emphasized science to the virtual exclusion of its art, leaving physicians with little mandate other than to diagnose and treat illness. That’s not a terrible g...
Source: Kevin, M.D. - Medical Weblog - February 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jeff-kane" rel="tag" > Jeff Kane, MD < /a > Tags: Physician Primary Care Source Type: blogs

On Data and Informatics For Value-Based Healthcare
This article seeks to demonstrate that the role of data and informatics in supporting value-based care goes much further than the collection and remote analysis of big datasets – in fact, the true benefit sits much closer to the interaction between clinician and patient. Data collection – costing and outcomes Costing Costing of healthcare for value should be done for the whole patient journey. This is important as it is not possible for value to be created in a service alone – it has to be assessed in terms of the outcomes delivered relative to the investment in all possible interventions for a particul...
Source: The Health Care Blog - February 15, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Data Informatics International United Kingdom value-based care Source Type: blogs

Why workplace wellness programs don ’t work
A study from the National Bureau of Economic Research reports on the results of a large randomized controlled trial of a large employer with over 12,000 employees. Program eligibility and financial incentives were randomized at the individual level. Over 56 percent of eligible treatment group employees participated. The study found that in the first year, the employees who signed up were healthier and had lower medical costs, but, and this is very important, they concluded we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-re...
Source: Kevin, M.D. - Medical Weblog - February 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/richard-young" rel="tag" > Richard Young, MD < /a > Tags: Physician Primary Care Public Health & Policy Source Type: blogs

How doctors should think: Heuristic thinking isn ’t heretical
Doctors are intelligent people, but are we good thinkers? And how should we think? There are two basic kinds of thinking: analytic and intuitive. (And maybe good and bad, so that’s four.) Within medicine, analytic thinking can perhaps be best exemplified in the evidence-based movement, which began in the early 1990’s. It was a gilded age, full of promise, and bolstered by the reality that computers would give physicians instant access to the most thoroughly researched standards of care. Within our specialty of internal medicine, we watched the sacred texts of medical wisdom — Cecil, Harrison&rsq...
Source: Kevin, M.D. - Medical Weblog - February 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/craig-bowron-and-michael-cummings" rel="tag" > Craig Bowron, MD and Michael Cummings, MD < /a > Tags: Conditions Primary Care Source Type: blogs

I ’m speed dating my doctor
I’ve been single for nearly a decade. A career-driven professional, juggling parenting, PTA, and post-graduate studies, my time is precious. But there’s something about this season — the heart-shaped Valentines and assorted chocolates — that has a way of evoking a longing for love. So this year, bowing to the goading of friends and against my better judgment, I decided to do something I never — never — thought I’d try. I went speed dating. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (S...
Source: Kevin, M.D. - Medical Weblog - February 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/elizabeth-metraux" rel="tag" > Elizabeth M étraux < /a > Tags: Physician Primary Care Source Type: blogs

2018 Forecast: Another Theranos, Hospital Hiring Slows & Successful HIT Exits
By BOB KOCHER, MD and BRYAN ROBERTS For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. In 2017, amaz-ingly, eight of our predictions came true. For 2018, we are betting on the following: 1. Another Theranos We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose e...
Source: The Health Care Blog - February 13, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Bob Kocher Bryan Roberts Venrock Capital Source Type: blogs

This doctor doesn ’t go to patients’ memorial services
Patients and their family members are impressed when doctors show up for memorial services. They tell me about it. “The doctor liked my mother so much that he came to her wake,” a patient recently confided in me as I examined her. She had been a sole caregiver for her aging parents for years, and her mother had passed a few months earlier. The physician’s presence at her mother’s service provided a source of comfort, and I could understand why. Attending wakes was a deeply rooted tradition in the Irish Catholic community of my childhood. As a young girl, I can remember many times sitting in the car ...
Source: Kevin, M.D. - Medical Weblog - February 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/lauren-kuwik" rel="tag" > Lauren Kuwik, MD < /a > Tags: Physician Primary Care Source Type: blogs

Addressing the Social Determinants of Health in Primary Care
The EveryONE project is an initiative from the American Academy of Family Physicians focused on helping primary care physicians learn about and address the social determinants of health. Their toolkit includes a guide on the social determinants of health as well as screening tools that primary care physicians can use to screen their patients for social and environmental concerns that may be affecting their health. (Source: BHIC)
Source: BHIC - February 12, 2018 Category: Databases & Libraries Authors: Erin Seger Tags: Websites Source Type: blogs

The Fusobacterium story as of 2018 – a very long post
This study followed a previous study that suggested an incidence of 1 per million.  However, in this study they estimated 14.4 per million in the 15-30 age group.  This rare disease now did not seem quite so rare. This information caused me to think about the risk to adolescents and young adults from Fusobacterium pharyngitis.  Much thought led to this perspective published in the Annals of Internal Medicine: Expand the Pharyngitis Paradigm for Adolescents and Young Adults Robert M. Centor, MD Current guidelines and review articles emphasize that clinicians should consider group A !-hemolytic streptococ...
Source: DB's Medical Rants - February 11, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Talk About What Goes Around Comes Around!
A very long time ago I was involved in a project to try and define what a decent GP system might be able to do and how it might be architected. This was in fact late last century!!!This page contains a lot of interesting history and some ideas which still do not look that silly:http://ozhealthithistory.wikispaces.com/General+Practice+Related+FilesIn the light of the various memos going around with the ADHA, the MSIA, the RACGP and so on it is worth just seeing for how long all this has been discussed etc.Enjoy the browse. The last entry (a paper describing what went on in the project) is a good introduction and still looks...
Source: Australian Health Information Technology - February 11, 2018 Category: Information Technology Authors: Dr David More MB PhD FACHI Source Type: blogs

A medical student was discriminated against by a patient
On my outpatient family medicine rotation, I met a patient I will never forget. She was a white middle-aged woman — a new patient to the clinic — there to establish care. When I walked in and introduced myself, she looked me up and down with a glazed expression. Within two minutes, while I was trying to gather a history from her, the patient interrupted to say, “Dr. Smith (name changed), isn’t he the best? It’s so refreshing to finally find an all-American doctor.” I knew from that statement that this conversation was about to take a turn for the worst. “All the immigrant doctors a...
Source: Kevin, M.D. - Medical Weblog - February 10, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nada-awad" rel="tag" > Nada Awad < /a > Tags: Education Primary Care Source Type: blogs

Fight the opioid crisis with physician assistants
With over 300,000 opioid-related deaths reported since 2000 and two million patients battling addiction today, it’s evident that more qualified medical providers are needed to care for substance abuse patients. Psychiatrists and addiction specialists are struggling to meet the demands of this high need population. The good news amid this national health care epidemic is that more than 1,200 certified PAs practicing in psychiatry work hard to help fill these care gaps. With medical education supplemented by post-graduate training by psychiatrists, PAs in psychiatry are prepared to review medication histories, engage w...
Source: Kevin, M.D. - Medical Weblog - February 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/james-cannon" rel="tag" > James Cannon, PA-C < /a > Tags: Policy Pain Management Primary Care Source Type: blogs

Who ’s really to blame for physician burnout?
The subject of physician burnout has become a major point of contention in our community. Institutions try to help by implementing “mindfulness programs” or bringing in “burnout experts” for a one-time lecture. Physicians complain that the system is flawed and mindfulness is just another way for them to “blame the victim” for being burned out. Meanwhile, there are doctors who are simply trying to survive through each day; they walk around with a straight face, (and some with smiles), acting like all is well, while they secretly are suffering in silence. The shock comes when those doctors...
Source: Kevin, M.D. - Medical Weblog - February 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/maiysha-clairborne" rel="tag" > Maiysha Clairborne, MD < /a > Tags: Physician Practice Management Primary Care Source Type: blogs

Racists drove a doctor from the U.S.
Steve was special — even as an intern and first-year resident. Out of more than two hundred letters of recommendation for our physician trainees I’ve written over the last fifteen years, I have only written this statement a few times: “Steve has the clinical acumen, integrity, work ethics and wonderful bedside manner that would give me full confidence in having him care for my family member.” Steve eventually finished seven long years of medical training and got the opportunity to serve as a cardiologist in an underserved region of Maine. He and his family from the Middle East were excited about sta...
Source: Kevin, M.D. - Medical Weblog - February 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/chi-huang" rel="tag" > Chi Huang, MD < /a > Tags: Physician Primary Care Source Type: blogs

Supporting nurse mentors to reduce the barriers to implementing alcohol Interventions and Brief Advice (IBA) in primary care
Alcohol Research UK -This project aims to reduce barriers to the implementation of alcohol IBA in primary care by providing expert support to nurse mentors to: develop a leadership role in IBA including provision of ongoing training and support to staff members; and encourage ongoing evaluation of activity and outcomes in IBA.ReportAlcohol Research UK - publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - February 9, 2018 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: Local authorities, public health and health inequalities Source Type: blogs

Expert advice on how to quit smoking
Okay, everyone knows smoking is bad for you, the number one cause of preventable death in the US and the world, a direct cause of lung and heart disease and cancer… et cetera. So let’s get right down to the nitty-gritty: quitting smoking is tough. What can people do to quit? To answer this question, I spoke with my colleague Nancy Rigotti, MD. Dr. Rigotti is director of the Massachusetts General Hospital Tobacco Research and Treatment Center. She has extensively researched nicotine and tobacco, evaluated public policies on tobacco, contributed to US Surgeon General’s Reports, and authored clinical guidel...
Source: Harvard Health Blog - February 8, 2018 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Health Heart Health Lung disease Prevention Smoking cessation Source Type: blogs

People who grieve can live again
An excerpt from The Only Way Out is Through: A Ten-Step Journey from Grief to Wholeness. “Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break.” – William Shakespeare, Macbeth, Act III, Scene III Mourning is about reality. At the very beginning, your body tries to save you, to keep you from taking the full thrust of your grief. You find that you use phrases to help you take that loss in small increments so that you can stand the pain, bit by bit. You may hear yourself say that your loved one is lost, or gone, or that he isn’t with you anymore. Howev...
Source: Kevin, M.D. - Medical Weblog - February 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/gail-green" rel="tag" > Gail Green, PhD, EdD < /a > Tags: Conditions Primary Care Source Type: blogs

The unintended effects of physician side hustles
A movement is growing in the underbelly of the internet. On Facebook, a group called Physician Side Gigs has over 11,000 physician members trading tips and words of encouragement with other doctors looking to supplement their clinical careers via side hustles.  Physician on Fire and the White Coat Investor are encouraging doctors to achieve financial independence in order to relieve ourselves of the daily grind from work and experience freedom.  There are several reasons for doing these side ventures, i.e., creative outlets or creating passive income streams, but the harsh reality is, there is an underlying ...
Source: Kevin, M.D. - Medical Weblog - February 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/millennial-doctor" rel="tag" > Millennial Doctor, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

Vaccinations: More than just kid stuff
Follow me on Twitter @RobShmerling This is the time of year when it’s important to think about flu vaccinations. And there’s good reason for that! The flu causes thousands of preventable hospitalizations and deaths each year. But what about other vaccinations? Do you think of them as something for kids? You aren’t alone. And it’s true, a number of vaccinations are recommended for young children as well as preteens and teenagers. These vaccinations have provided an enormous benefit to public health by preventing diseases that were common and sometimes deadly in the past, including polio, rubella, and...
Source: Harvard Health Blog - February 7, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Infectious diseases Prevention Vaccines Source Type: blogs

Eponymythology: Diffuse Toxic Goitre
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Despite a drive to provide a consistent, modern nomenclature for signs, symptoms, diseases, procedures, equipment and medical conditions…eponyms still persist. We review 500 *common eponyms, the person behind their origin, history, accuracy, relevance today, modern nosology and their eponymythology. The problem of nomenclature of diffuse toxic goitre (Parry, Graves or Basedow disease) remains an unsettled one. So lets review the chronological history of eponym...
Source: Life in the Fast Lane - February 6, 2018 Category: Emergency Medicine Authors: Mike Cadogan Tags: Eponymythology Basedow disease Caleb Hillier Parry exophthalmos goiter Graves disease Karl Adolph von Basedow Parry disease Robert James Graves thyroid Source Type: blogs

Will Amazon Eat the Market?
By PAUL KECKLEY Last Tuesday, a trio of corporate heavy weights announced they were joining forces to fix the U.S. healthcare system. The CEOs of the three—Jeff Bezos of Amazon, Warren Buffet of Berkshire Hathaway, and Jamie Dimon of JP Morgan, vowed to create “an independent company that is free from profit-making incentives and constraints..to provide simplified, high-quality and transparent healthcare at a reasonable cost.” Details about the proposed venture are limited but it nonetheless sent shock waves across the industry. Stocks for industry mainstays like United Health, CVS, Express Scripts, Mylan...
Source: The Health Care Blog - February 5, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

What physicians what their patients to know: 13 more things
After reading “13 things every doctor wants their patients to know,” here are 13 more things good doctors wish their patients knew. 1. We need the complete truth. I feel for patients who hesitate to reveal something embarrassing. But we hear so much. Very little shocks us. Also, we realize we haven’t walked a mile in your shoes. Or an inch. We take in the facts and get down to the work of helping you. But we need the straight truth. This means telling us what drugs you’ve taken, legal and illegal, to avoid drug interactions. Or telling us exactly when you last ate before surgery to minimiz...
Source: Kevin, M.D. - Medical Weblog - February 5, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/joanne-jarrett" rel="tag" > Joanne Jarrett, MD < /a > Tags: Physician Primary Care Source Type: blogs

A Doctor ’s Painful Struggle With an Opioid-Addicted Patient - Siddhartha Mukherjee - The New York Times
I once found myself entrapped by a patient as much as she felt trapped by me. It was the summer of 2001, and I was running a small internal-medicine clinic, supervised by a preceptor, on the fourth floor of a perpetually chilly Boston building. Most of the work involved routine primary care — the management of diabetes, blood pressure and heart disease. It was soft, gratifying labor; the night before a new patient's visit, I would usually sift through any notes that were sent ahead and jot my remarks in the margins. The patient's name was S., I learned. She had made four visits to the emergency room complaini...
Source: Psychology of Pain - February 5, 2018 Category: Anesthesiology Source Type: blogs

A drug problem in rural Georgia
Meet Johnathan, a 34-year-old male from rural Georgia we recently treated for back pain as a result of some extra contractor work he took on over the holidays.  We see patients like him every 11 minutes, which doesn’t leave much time to get beyond Johnathan’s chief complaint.  He leaves with his first prescription for opioids. *** Of the 91 Americans taken each day, Georgia now claims four, or more than twice our share.  Deaths from prescription opioid overdoses increased tenfold between 1999 and 2015, compared to fourfold nationally, putting us among the nation’s top 10 states with the mos...
Source: Kevin, M.D. - Medical Weblog - February 5, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/ashish-advani" rel="tag" > Ashish Advani, PharmD < /a > Tags: Meds Pain Management Primary Care Source Type: blogs

Refreshing NHS plans for 2018/19
NHS England - This guidance, published jointly with NHS Improvement, sets out the plans for the NHS in light of the November 2017 budget announcements. It outlines how the additional funding will impact on emergency and urgent care, elective surgery and other core frontline services such as mental health and primary care. It is accompanied by revised CCG allocations for the financial year 2018/19.GuidanceFurther information (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - February 5, 2018 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: NHS finances and productivity Regulation, governance and accountability Source Type: blogs

Divided we fall: getting the best out of general practice
This report finds that initiatives that offer faster and easier access to GPs for some patients risk undermining the ability of doctors to manage people with complex or unknown illnesses and keep them out of hospital. It calls on national policymakers to move away from splitting off services and to support better access, better continuity and medical generalist care within GP organisations.ReportPress release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - February 5, 2018 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: Developments in primary and community care Source Type: blogs

Think twice before tapering opioids in some patients
Bill is a 58-year-old male with a history of head and neck cancer as well as chronic low back pain who presents to his new primary care doctor for a routine checkup and visit for a medication refill. He works in construction and has been on chronic opioid therapy after his cancer — with a stable dose of 15 mg of oxycodone for over five years. At his new primary care visit, after a few meet and greet pleasantries, his new primary care doctor discusses his current medication regimen with him — ibuprofen 400mg TID and oxycodone 15mg BID. His physician expresses significant concern with his medication regimen, tell...
Source: Kevin, M.D. - Medical Weblog - February 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/casey-grover-and-lee-goldman" rel="tag" > Casey Grover, MD and Lee Goldman, MD < /a > Tags: Conditions Oncology/Hematology Source Type: blogs

Concierge medicine sucks for specialists. Here ’s why.
As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that. Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients immediately. We all understand how this works. The physician takes a fee to make sure that their patient is navigated through the health care system expeditiously and hopefully ap...
Source: Kevin, M.D. - Medical Weblog - February 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Physician Primary Care Source Type: blogs

Think critically about for-profit donor entities and their commitments to health
At my job as a primary care doctor in a federal safety net clinic, I was given a free T-shirt to wear the following day. It reads “Crucial Catch — Intercept Cancer” in between the logos of the National Football League (NFL) and the American Cancer Society (ACS). This celebrates the 8-year partnership of almost $18 million dollars donated to fund cancer screening and prevention. These philanthropic gestures of large donors help to fund valuable projects and raise visibility, as demonstrated by my entire clinic staff getting ready to sport their campaign gear. However, recent history of the NFL delinea...
Source: Kevin, M.D. - Medical Weblog - February 2, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/emi-okamoto" rel="tag" > Emi  Okamoto, MD < /a > Tags: Physician Cardiology Neurology Source Type: blogs

Why medical scribes are accidental blessings
Some doctors choose medicine because of the medicine, and some doctors choose medicine because of the people. I veer towards the latter: Medicine is my tool to help the person sitting across from me. However, I am finding more and more stuff getting in between me and my patients, primarily my computer. The increasing burden of gathering coded health data in the EMR, especially in light of the impending MACRA, MIPS regulations and the various private insurance compliance requirements, has proven generally ineffective in improving patient care and health outcomes. If you compare health IT to other major industries, the medic...
Source: Kevin, M.D. - Medical Weblog - February 2, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jonah-mink" rel="tag" > Jonah Mink, MD < /a > Tags: Physician Health IT Primary Care Source Type: blogs

CAREGIVER ALERT: The Connection Between Gum Disease and Alzheimer ’s Disease
A recent research study showed that the presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in dementia patients.By Rita Jablonski and Bob DeMarcoAlzheimer ’s Reading RoomBottom line: gum disease can hasten memory loss and hasten the progression of Alzheimer's disease.Most people know that keeping teeth and dentures clean makes the person with dementia feel good,but mouth care goes beyond “feeling” good.Healthy teeth and gums can keep the rest of the body healthy.About the Alzheimer's Reading RoomSubscribe to the Alzheimer's Reading - This is a Free Service - J...
Source: Alzheimer's Reading Room, The - February 2, 2018 Category: Neurology Tags: alzheimer's and dental health alzheimer's and dentures alzheimers gum disease flossing and dementia oral hygiene and dementia Source Type: blogs

CAREGIVER ALERT: The Connection Between Gum Disease and Alzheimer's Disease
A recent research study showed that the presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in dementia patients.By Rita Jablonski and Bob DeMarcoAlzheimer ’s Reading RoomBottom line: gum disease can hasten memory loss and hasten the progression of Alzheimer's disease.Most people know that keeping teeth and dentures clean makes the person with dementia feel good,but mouth care goes beyond “feeling” good.Healthy teeth and gums can keep the rest of the body healthy.About the Alzheimer's Reading RoomSubscribe to the Alzheimer's Reading - This is a Free Service - J...
Source: Alzheimer's Reading Room, The - February 2, 2018 Category: Neurology Tags: alzheimer's and dental health alzheimer's and dentures alzheimers gum disease flossing and dementia oral hygiene and dementia Source Type: blogs