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Primary Care: Will NPs replace MDs?

More unhealthy people are being herded into our healthcare system and more doctors are exiting. That’s the perfect formula for chaos.

I’d like to welcome the nursing profession here to save the day. Nurses have taken up the call for providing that missing link of access as doctors disappear. The expansion of nursing care to replace medical care in primary care is just the beginning of the next phase of American medicine. It all depends on how you define primary care. What can be cheaper must be done cheaper. Read more »

*This blog post was originally published at The Happy Hospitalist*

What Would It Take For You To Give Up Tobacco?

I was shopping the other day for Sam’s Club food (frozen blueberries 4 pounds for $7.50). As we checked out, I scanned the price of cigarettes behind the counter. Marlboro cigarettes were selling for just under $50 a carton. At one pack per day, that’s $150 a month. For a year, that works out to $1,800.

I once calculated how much a four-pack-a-day family could have had in the bank had they not smoked for fifty years and instead invested that money at standard returns. Six million dollars they’d have to enjoy in retirement. That’s amazing. Six million dollars. And we wouldn’t be talking about a bankrupt entitlement system. Read more »

*This blog post was originally published at The Happy Hospitalist*

A Link Between Depression and Female Baldness

Female-Hair-LossA reader sent me this really sad story that got me thinking about hair restoration for women:

Happy, I wanted to share with you this picture of a woman who’s lost all hope. I saw her a few years back during my psychiatry rotation. As you can see, it looks like she’s going bald, but in fact, during her fits of rage and depression she’s actually pulling out her own hair. How sad is that? Just another example of what we docs take care of on a daily basis. 

Man, that’s unbelievable. I don’t know much about classic female pattern baldness. From what I’ve read it’s usually a diffuse loss of hair everywhere or  a central expansion of hair loss but rarely does it encompass the entire scalp. It’s usually caused by hormones, aging and genes. In advanced age, I’ve seen more than my fair share of elderly women who have more hair on their chin then they do on their head. Read more »

*This blog post was originally published at The Happy Hospitalist*

Why The Healthcare Reform Bill Is Racist

We learn from the healthcare reform bill that the federal government will help subsidize Medicaid funding for all the new patients who qualify, but they will only do it for two years. After that, the states are on their own. Medicaid unfunded liabilities will crush state governments everywhere.

Why is Medicaid so expensive and going bankrupt? I’ll give you one example why. This is played out day after day, night after night in communities all across our country. And the only ones paying for it are you and me. The ones spending all the money have no incentive to stop.

I’m in the ER the other day when I see a chief complaint fly by on the radar. What is that chief complaint, you ask? Let me tell you a story.

Refused By Detox

The patient was so drunk even the community detox center refused him. So how did this play out? The patient was taken by ambulance from his home to a small-town community ER for altered mental status. There he was checked into the ER and seen by a small-town community ER physician, family practice resident, or PA or NP.

Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox center. Read more »

*This blog post was originally published at The Happy Hospitalist*

A Gene For Surviving Dialysis

As a hospitalist physician of seven years and taking care of dialysis patients, I’ve come to the conclusion that a dialysis survival gene exists. I talked with a nephrologist the other day about dialysis survival. Here’s what he said:

“If you take all dialysis comers, every year 25% of them will die.”

There is a broad range of dialysis survival. A 94-year-old with severe COPD, CHF, and dementia will not have the same survival statistics as a healthy 27-year-old with acute interstitial nephritis. The protoplasm from which you begin with often times determines the dialysis survival.

There are many factors that determine dialysis survival statistics. Some of them include, age, race, weight, and even the length of the dialysis treatments. But no where have I seen reported the association of dialysis survival with Happy’s presumed dialysis surivival gene. Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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