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An Open Letter To My Pancreas

Unemployed pancreas.

Dear Pancreas,

I’m not sure what the hell happened to you, but you’ve taken it upon yourself to stop working.  You did have that job for about six years, where you got up early every day and produced my insulin, but apparently that was too much for you.  You were laid off or fired or something.  Don’t blame it on that virus again.  I think you just slept through the alarm and were let go and you just don’t want to admit it.

All you do is sit around, hiding out behind my stomach, reading smut novels and watching reruns of The Facts of Life.  Sure, you push out the occasional juices and you can sound important when you talk about “trypsinogen” and “chymotrypsinogen,” but you and I both know that you don’t do much.  It’s not even like you empty the dishwasher or anything.  The least you could do, after I’ve been testing blood sugar levels and bolusing all day long, is have dinner on the table when I come home.  Is that too much to ask? Read more »

*This blog post was originally published at Six Until Me.*

What To Do When Your Patient Wants To Leave The Hospital Against Your Better Judgment?

When a patient decides they are leaving against medical advice what responsibility does the physician have to their care?  When I was a resident in training, and even early on in my position as a hospitalist, I would get a call from the nurse that  Mrs Smith was demanding to leave the hospital against medical advice.  I would tell the nurse “Fine. Let her go. I’m not her father.”  I would tell the nurse to discharge Mrs Smith with no medications and leave it up to them to find follow up.

I would suspect this is a prevalent attitude for many hospital and emergency based physicians.   I’ve seen it over and over again.  And I still see it today.  Many doctors and nurses feel obliged to let grown men and women make poor decisions.    However, being a grown man or woman able to make poor decisions is apparently not enough to keep a doctor for being sued and losing that lawsuit because a patient chose to make poor decisions.   Read more »

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

Should Massachusetts Pay For Mississippi’s Healthcare?

As I have been predicting for a long time, state insurance regulators were unlikely to remain silent for long in the face of efforts to federalize major parts of state insurance regulation.  They’re talking now, and they’re  mad.

Last week, Connecticut Insurance Commissioner Thomas Sullivan testified in Congress on behalf of the National Association of Insurance Commissioners.  He said that federal regulation must not displace the current system of state regulation. Calling the proposed legislation a “regime change,” he said it would result in “redundant, overlapping responsibilities will result in policyholder confusion, market uncertainty, regulatory arbitrage and a host of other unintended consequences.” Read more »

*This blog post was originally published at See First Blog*

One Doctor’s Fight To Get His Patient The Right Medication

“Doc, I’ve got good news and bad news.”

“What’s that?”

“Well, I’ve lost six more pounds!”

“Wonderful! What’s the bad news?”

“Well, you know that new-fangled drug you gave me that works so well for my atrial fibrillation?”

“Yes.”

“We’ll, I’m part of that AARP Medicare Advantage Part D drug plan, and I just got the “partial” approved drug list for 2010 in the mail. My drug’s not on the list, so I called and found the drug’s been moved from a Tier II drug to a Tier III drug. That means it will cost me twice what I paid for it this year. That’s gonna be tough, doc. I can’t afford it.

But I also read that if you call this ‘800’ number and speak to them, they’ll allow me to obtain an exemption to keep the drug on Tier II for next year.” Read more »

*This blog post was originally published at Dr. Wes*

All Teens Under Pressure To Be Above Average

My heart is going out to teens these days, especially in my high-achieving community. It seems school districts and parents alike have lost the sense that “average” is really OK, and in some cases, much healthier than “above average.”

An emotional goal of adolescence is to answer the question “who am I” acquiring self-certainty as opposed to self-consciousness and self-doubt. Most teens approach life expecting to succeed and achieve their goals rather than being paralyzed by feelings of inferiority. On a normal path, adolescents seek out people who inspire them and gradually develop a set of ideals and goals for their future. This is all perfectly normal, and if all goes well, teens become young women and young men who believe they can do whatever they set their minds to and are willing to work hard enough for. This process gets stunted if the expectations set for them are unreasonable. Read more »

This post, All Teens Under Pressure To Be Above Average, was originally published on Healthine.com by Nancy Brown, Ph.D..

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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