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Hysterectomy for chronic pelvic pain: 7 questions to ask

Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15 percent of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a […]

Brugada syndrome: the latest

Here's a new review.From the article: Originally, three repolarization patterns were described: a) Type-1 ECG pattern, in which a coved ST-segment elevation greater than or equal to 2 mm is followed by a negative T-wave, with littleShow More Summary

The problem with “measuring quality” – as Donabedian told us

So who is Donabedian? He wrote the classic paper “Evaluating the Quality of Medicare Care” in 1966. Most researchers and experts revere the Donabedian formulation. I would argue though that many advocates of P4P need to read Donabedian. I will give a few quotes from his paper as food for thought: Which of a multitude […]

Hardly anyone is opening their own practice anymore. Why?

Young doctors are often progressive thinkers who like to support small businesses, buy locally grown produce from food shares, shop from individual merchants on Etsy, and never be seen in any chain store larger than Trader Joe’s. It seems every industry is recognizing the benefits of the personal service of a small business. Continue reading […]

Unity Farm Journal - Christmas at the Farm

It’s Christmas Day on Unity Farm and the every creature has had extra attention, special meals, and new toys.What better gift for our livestock guardian dogs (Great Pyrenees) than soft fluffy beds in the barn loft? As the pictures below illustrate, this was an ideal gift - the most fun they have had all year tearing each bed into a 1000 pieces. Show More Summary

The people who will cure cancer are the patients

Sometimes I tell people I’m learning how to treat cancer, and their first question is ‘why haven’t we cured cancer yet?’ We will.  It’s coming. In medicine we’re much better at treating infections than cancer, but it wasn’t always that way: We didn’t know washing your hands before delivering a baby wassafer for women until 1847. The […]

Number of ACOs will grow in 2015 serving more than 72 million patients.

Link: New ACOs According to a news release in Healthcare Finance, " The number of accountable care organizations in Medicare’s Shared Savings Program will grow by 89 in January 2015, the Centers for Medicare and Medicaid said this week, boosting the total participants to 405. Show More Summary

Should sick kids be allowed at daycare?

I see it all the time at our practice. Parents come with kids who really don’t need to go to the doctor; they are only mildly ill, or already getting better. When I ask them why they came, the answer is simple: daycare. They need a note saying the child is better in order for […]

How many doctors does it take to read a hospital bill?

Traveling to another country can be daunting. So when a friend of mine hosted a Russian college-aged student named Anna for a year so she could take English classes, I agreed to help out if she ever needed to navigate the American medical system. Anna had insurance provided through her program, and she was in […]

Competition helped innovate computers: Can it do the same for health care?

My lifetime has spanned many of the important developments in the Age of Computers. Back in 1969 when I entered college, I was a frequent visitor to the Kiewit Computing Center, the lair of a GE-635 computer that filled several rooms. Students had access to the computer via noisy teletypes and a multiuser operating system known as […]

Having a sibling with special needs: A challenge for the whole family

Being sick isn’t easy, but neither is being the sibling of someone who’s sick. We’ve shared many stories about children who are living with a serious illness. We’ve talked about their disease, what life is like for them, how they cope in such dire circumstances. But in all of these conversations, one thing we’ve overlooked […]

Matt Herper’s Most-Read (And Favorite) Stories For 2014

As a look back at the year, here are my most-read stories from 2014, and a list of some of my other favorites. Matt’s Most-Read Stories 1. Why Thousands Of Men Like JPMorgan CEO Jamie Dimon Are Getting Throat Cancer 2. Think The ALS Ice Bucket Challenge Is Stupid? You’re Wrong. 3. Here Is What ’60 Minutes’ Didn’t […]

An attending threatens patient safety. A resident blows the whistle.

My department had a problem that harmed patients on at least a weekly basis. It was well-known, but it seemed there was no viable solution. My supervising attending was in his seventies and highly regarded at my hospital, having held powerful administrative positions for decades. About ten or so years ago, he stepped down from […]

Sovaldi: The drug pricing paradigm has shifted

Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly effective in the treatment of chronic hepatitis C (HCV) infection. Show More Summary

Merry Christmas to All

2 days agoIndustries / Medical : Dr. Wes

To every person who finds themselves sick or alone this holiday season. To the many caregivers who toil without recognition this day and the next. May the peace and joy of this holiday season transcend it all as we pause and reflect on what really matters. Merry Christmas and Happy Holidays to all. -Wes

Dear HMO, I don’t want your money

Dear HMO, As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs.  Unfortunately, this is not the case for many Americans.  Most importantly, I know to avoid signing up for certain health maintenance […]


From a recent review: Canagliflozin, a novel agent that lowers plasma glucose by decreasing glucose reabsorption at the proximal tubules of nephrons, inhibits the sodium–glucose cotransporter 2. Data suggest a decrease in hemoglobinShow More Summary

An ER patient that stirs every emotion

Despite the furious pace of the emergency department, he sat within his private bubble of calm on a hallway cot situated just outside the entrance of room 31. He sat upright, facing the opposite direction from which I approached, with the thinning brown hair of his broad occiput splayed across the upper edge of his […]

Present Future Tense

I’m often asked by hedge funds, investors, and private equity firms to evaluate start ups based on their management savvy, product maturity, and business models.I’ve been on several calls with startups in 2014 in which the grammar was all “present future tense”"We will have a product that does…"My response to the investors is to clarify1. Show More Summary

Behind the Scenes: EMS1 Article about Presidio EMS

Presidio EMS is featured in the End of Year coverage. The article, How one rural EMS agency shines at innovative patient care, came to be for these reasons: An EMS1 reader recommended to me that I contact the service director. The service director rapidly replied to my email inquiry Replies to subsequent questions/clarifications were […]

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