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National Ambulatory Medical Care Surveys (NAMCS) persistently indicate that problems diagnosed as “mental and behavior disorders” account for at least 20% of visits in primary care practice. One of the most difficult tasks for primary care physicians has been the discussion with patients and families about disorders whose resulting behaviors either make patients unhappy or make people they interact with unhappy. Despite several Federal laws requiring employers, health insurers, and health ca

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The 2001 IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified six fundamental aims for healthcare — that it be safe, effective, patient-centered, efficient, equitable, and timely. Of these, “timeliness is in some ways the least well studied and understood,” the IOM says. The new report, Transforming Health Care Scheduling and Access: Getting to Now, aims to answer two questions: How can timely care be ensured in various healthcare settings

Time To Get Smart!

Yes, my wife, Lisa thinks I am crazy and she may have a valid point. Nevertheless, the importance of my decision to write the 3rd edition of my medical textbook Diabetes Management in Primary Care was based on providing better care for my own patients. Really? How can writing a 700 page book help you, my patients? Writing a medical text book is no easy task. Unlike writing a fictional novel, the text book must be provide accurate information while providing guidance to physicians on how best to

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Sleep is an integral part of life. All animal require sleep, foot, water and oxygen in order to survive. For most of us, 7-9 hours of uninterrupted sleep is necessary to maintain our health. Interestingly, sleep deprivation for 11 days is unsustainable and will result in death whereas we can survive for 3-4 weeks without food. Sleep deprivation can lead to loss of memory, irritability, muscle pain, confusion, car accidents, falls, diabetes, hypertension, weight gain, heart disease and depression

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Making a self-diagnosis of acute appendicitis is unpretentious especially when the patient is a family physician with over 30 years of clinical experience -right lower quadrant pain, increasing in intensity over a three day period associated with anorexia and chills. I arranged to undergo the appropriate tests which corroborated my diagnosis. After calling the surgeon, I headed to the hospital for the appendectomy. However, from the moment I arrived in the emergency room, until the time I was di

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Patients often bemoan about having to live with the daily disturbances and challenges required of diabetes self-management. Counting carbs, taking medications with names longer than Greek Gods none of which are covered by insurance, having to monitor blood glucose levels three to six times daily and even having to incorporate healthy foods and exercise into daily living can elicit a feeling of distress in most patients with diabetes. Those individuals who are suffering from diabetes are indeed l

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I was feeling anorexic and chilled as I sat with my wife at a local diner. The right lower quadrant pain that had been worsening over the past 3 days could no longer be ignored. “I have acute appendicitis,” I told my wife. “I need to go to the radiologist.”A computed tomography (CT) scan of my abdomen confirmed my suspicion. After learning that I also had leukocytosis, we headed to the emergency department (ED). The ED doctor was pleasantly surprised that someone had come to his facil