The last breath can be seen as a the passage into eternity

Physician
March 24, 2015

Eonia I Mnimi (Eternal Memory) 
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

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Are cardiac risk calculators accurate?

Conditions
March 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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What does it mean to live in the age of Abilify? 

Meds
March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S.  To be a top seller, a drug has to be expensive and also widely used.  Abilify is both.  It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill.  Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill.  A little more …

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Heart-wrenching photo of a doctor crying goes viral. Here’s why.

Physician
March 20, 2015

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Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”

Thousands of people have …

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Eulogy for the doctor

Physician
March 17, 2015

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No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damages  … “
– Assaults Upon Medical Men. Journal of the American Medical Association, 1892

It’s happened again: A well-liked doctor is killed by his patient. Last year’s horrific death of a physician in our community, a …

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3 myths and 3 truths about hospice

Physician
March 17, 2015

As I travel around speaking about preparing for peace at the end of life, I have found that there are three pervasive myths about hospice that might cause you to inadvertently rob yourself or your family of a peace-filled end-of-life experience.

So, I am taking on the job of myth-buster to clear the air. Here goes:

Myth #1: Hospice is a place. While hospice can be a place, it is primarily a service. …

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Surprise! When it comes to a vaginal hysterectomy, this insurance company gets it right.

Conditions
March 16, 2015

The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an …

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We are overprescribing statin medications for high cholesterol. Here’s why.

Meds
March 16, 2015

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

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10 secrets to success as a female surgeon

Physician
March 13, 2015

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I bolted through the conference room door on the first day of residency orientation.  The room full of interns shifted in their seats.  All one dozen of the faces looking up at me were male.  I got some crooked, goofy grins.  So began my introduction to the world of surgery.

So, what would I tell my daughter about how to survive and …

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The ABIM response to Newsweek determines how far anti-MOC sentiment will spread

KevinMD
March 13, 2015

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Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).

The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine.  Go read it.

The ABIM subsequently released a strongly-worded statement.  They are clearly not happy with the mainstream media spread …

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A surgeon will always have two spouses

Physician
March 12, 2015

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I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, …

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Ease the transition to hospital medicine

Physician
March 11, 2015

I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I …

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Why can’t physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants just get along?

Physician
March 10, 2015

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American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.

In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is …

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Pay doctors and nurses for the time they spend charting

Physician
March 9, 2015

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I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.

One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I …

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Real-life examples of ultrasound in the developing world

Physician
March 8, 2015

In the last year and a half, I’ve been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I’m not actually vacationing.

Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how …

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Physician anesthesiologists do more than just “put you to sleep”

Physician
March 7, 2015

There have been huge advances in patient safety, but that doesn’t mean there is no risk when it comes to having surgery and anesthesia. Each year there are more than 100 million operations and procedures performed with anesthesia.  Doctors who specialize in anesthesia — we’re known as physician anesthesiologists — play a critical role in keeping patients safe and comfortable before, during, and after surgery.

Before surgery, a physician anesthesiologist checks …

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Don’t be scared: Let’s see what’s really in vaccines 

Meds
March 7, 2015

Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals.  But perhaps it is the unfamiliar ingredients that people find intimidating.

Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine …

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