Those who watch a spectacle share in the guilt of those who create it

Posted on 23. Apr, 2014 by in Education, Medical school

I stood right beside them as they slowly slid your head into a plastic bag, looped the coarse twine about your neck and tied it tightly. Like the amateurs they were, they double-knotted it to make sure nothing came loose or dripped out. Then they casually walked away, chatting about what would come next. Within [...]

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Small Business and the Affordable Care Act: How Has Your Business Been Affected?

Posted on 23. Apr, 2014 by in affordable care act, Health Law, Health reform, Small Business

The Affordable Care Act is having a lasting impact on small businesses, affecting how owners make decisions about hiring and managing staff, upgrading equipment and more.

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Sluggish cognitive tempo is a dangerous diagnostic idea

Posted on 23. Apr, 2014 by in conditions, Psychiatry

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered. And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced [...]

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Tort reform should not be controversial

Posted on 23. Apr, 2014 by in Malpractice, Physician

I’ve been in the medical malpractice arena many times, and always walked away unharmed. If this system were presented in front of a fair minded and impartial jury, it would be dismantled. Sure, there are positive elements present, but they are dwarfed and suffocated by the drawbacks. The self-serving arguments supporting the current system are [...]

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Can high-tech medicine also be high value?

Posted on 23. Apr, 2014 by in heart, Physician

“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart. “Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds [...]

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What do European doctors say about our guidelines for statins?

Posted on 23. Apr, 2014 by in heart, Meds

In November of last year the American Heart Association released to recommendations on who should be taking statins (drugs like Lipitor/atorvastatin), the most common medicines we use to control cholesterol levels. High cholesterol levels are associated with higher risk of heart attacks and strokes, and taking statins, which lower cholesterol, can reduce those risks. The [...]

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Lessons learned during an unplanned EMR downtime

Posted on 23. Apr, 2014 by in Health IT, Primary care, Tech

A guest column by the American College of Physicians, exclusive to KevinMD.com. On a Thursday in April, my practice upgraded its electronic health record to the next version, the “latest and greatest” with more features, as well as compliance with meaningful uses 2 through infinity. That was the good news. The bad news was that it meant [...]

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Top stories in health and medicine, April 23, 2014

Posted on 23. Apr, 2014 by in Cancer, Infectious disease, News, Pediatrics

From MedPage Today: Muscle Pain in the ED. Patients presenting to the emergency department with widespread muscle pain may have very low levels of vitamin D. Care of Cancer Survivors Often Falls Short. Most cancer patients enter survivorship with little direction from oncologists or primary care providers. MERS Cases Still Climbing. The number of cases of [...]

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A Tangled Web of Perversity by a Healthcare Company Owner – Subpoenaing Emails of Law Student Critics at NYU Law School, Where He is a Trustee

Posted on 22. Apr, 2014 by in Care One Management, Daniel Straus, First Amendment, HealthBridge Management, Leo Gertner, Luke Herrine, New York University, New York University School of Law, SEIU

At Healthcare Renewal, we are largely calling for removal from healthcare of perverse managers and perverse management practices. 

One of those practices is the attempted silencing of critics.

I have first hand experience with a perverse but unsuccessful attempt myself, where the apparently (and IMO, and as protected by the 1st Amendent) megalomaniacal management of a once-reasonable hospital (I did my residency there 1985-7) sought to abridge my 1st Amendment rights regarding care of my late mother.  See my August 11, 2013 post “Who Would Have Thought, Comrades, That The Most Severe Form of Attempted Internet Censorship Could Originate in a Community Hospital, Abington Memorial, That Alleges Itself A Non-Profit Public Servant?” at http://hcrenewal.blogspot.com/2013/08/who-would-have-thought-comrades-that.html.

This recent story, however, is simply stunning in the audacity of its principal regarding “shutting up” critics, this time two law students at a law school of which he is a Trustee:

Law School Trustee’s Company Chills Critical Speech With Subpoena For Students’ Personal Emails

Mon, Apr 21st 2014 1:14pm

A New York University trustee has found a way to chill speech critical of him and the [healthcare] companies he owns: subpoena the personal emails of two particularly outspoken opponents.

A New York University Law trustee’s company wants two students to hand over their personal emails after they circulated a letter criticizing him, according to a subpoena.

The law students, second-year Luke Herrine and first-year Leo Gertner, were targeted after they helped circulate a letter denouncing NYU Law School trustee Daniel Straus, who owns Care One Management, a home health aide and nursing home company embroiled in a labor dispute.

The two students started a petition asking for the removal of Straus from the Board of Trustees, pointing out that a law school should probably be associated with someone who respects the law, something Straus’ companies seem to have trouble doing. His two companies, CareOne (http://care-one.com/) and HealthBridge Management (http://www.healthbridgemanagement.com/), have been cited at least 38 times by the National Labor Relations Board for violating federal labor laws. In addition, HealthBridge was held in contempt of court for refusing to allow 600 workers to return to their jobs at their pre-strike pay levels.

“A law school should probably be associated with someone who respects the law” seems an oxymoron, not to mention protected speech under the First Amendment of the U.S. Constitution: http://en.wikipedia.org/wiki/First_Amendment_to_the_United_States_Constitution.

CareOne’s current legal battle with a local labor union, Service Employees International Union (SEIU), something that has dragged on for years at this point, has seemingly turned into a convenient way for Straus to get back at his critics. Of course, CareOne claims otherwise.

CareOne spokesperson Deborah Maxson said the deadline for the requested information is April 25.

Straus is not a party to the lawsuit and is not managing the litigation,” Maxson said.

Straus may not be a party to this lawsuit, but these are his companies, and there can be very little doubt that Straus would prefer the ongoing criticism of his business efforts be halted. If CareOne wants to use the excuse that Straus isn’t a “party” to this lawsuit, then it needs to extend that same courtesy to the two students, who also aren’t a “party” to the ongoing legal fight.

But they’re defenseless students, and in healthcare matters, dissing a high-ranking healthcare management  person seems to be a crime that such persons cannot seem to tolerate.  (I won’t get into the psychopathological issues that may come into play).

Then there’s the content sought by the subpoenas. This, too, mentions Straus directly, even as CareOne claims this has nothing to do with him. According to a letter sent by the Board of Trustees to NYU administration, this is what CareOne is hoping to obtain:

The subpoenas requested information regarding any contact the students may have had with SEIU and any activity they may have engaged in, such as protests or meetings, relating to Mr. Straus or CareOne…”

If Straus isn’t “party” to this lawsuit, why does CareOne need information relating to Straus? Beyond that, the information requested bears all the hallmarks of trying to use the power of the court to silence free speech. Protests and meetings, both activities covered by the First Amendment, are mentioned specifically by the subpoena.

Perhaps some members of the generation after the “Greatest generation” have such low self-esteem that they have to bully mere students into submission.

For what it’s worth, NYU has stepped up and has provided the students with the pro bono help of one of the school’s lawyers. It also issued a very carefully-worded defense of the students, no doubt mindful of Straus’ $1.25 million annual endowment.

The Law School is not a party to the litigation between Care One and SEIU, and will remain uninvolved in it,” the school wrote in a statement to DNAinfo New York sent Thursday. “We vigorously support the right of our students to express their views and to organize and participate in lawful demonstrations and other protest activity, at the same time that we acknowledge that parties to litigation are permitted, subject to applicable rules and judicial oversight, to gather evidence in support of their case.”

Further statements reiterated NYU’s support for its students’ rights but also noted it considered Straus to be an “upright and honorable person.”

That said, it seems that there is a clear — and somewhat massive — conflict of interest for Straus to remain on the board of trustees at NYU Law at the same time he’s using the legal process to demand the email contents from two of its students.

Conflicts of interest are nothing new to healthcare.

As is noted by the students’ new petition demanding the withdrawal of the subpoenas, this sort of activity, undertaken by a “victim” of criticism, will discourage others from approaching anything remotely controversial.
Forcing students to turn over emails and other private communications in litigation that does not concern them can chill free speech on campus and make students think twice about raising their voice about controversial issues. This is antithetical to NYU’s mission of open academic inquiry and commitment to the public interest.

That’s assuming the mission of NYU and other universities still remains “open academic inquiry.”  Many have begun to doubt that, and with good reason; e.g., see http://www.bloombergview.com/articles/2014-04-22/free-speech-zones-and-other-college-lies as just one example.
Rather than address these concerns, Straus is allowing (or directing) his company to shut down his critics by seeking personal communications from non-party NYU students. Straus also has additional leverage with the university should this fail to keep future criticism at bay. Of course, there’s always a chance NYU will side with the students and decide that Straus’ companies don’t really reflect the culture it’s trying to instill in its students. But until this all plays out, we’re just witnessing the sort of tactics deployed by entities who would rather shut people up than address their concerns.

I note the following statement on the web page of Care One Management:

“With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.”

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.
- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.

- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.

- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf P { margin-bottom: 0.08in; }A:link { }

In healthcare, I remind, the “shut people up” mentality results in patient injury and death.  It seems to me that this Trustee is not just setting a bad example for the legal profession, but it also throws the management of his healthcare organizations into question.

– SS

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Primecuts – This Week In The Journals

Posted on 22. Apr, 2014 by in PrimeCuts

By Harry Saag, MD

Peer Reviewed

Roughly one year ago the city of Boston was in upheaval after two young men set off bombs in close proximity to the city’s landmark marathon, injuring hundreds of people. One year later the city was, once again, hosting its annual run with as much pride and fervor as ever. Despite the atrocities of last year’s events, it did not deter the city of Boston from forging on stronger than ever.

Similar analogies can be made regarding progress in…

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Doctors and nurses are being overloaded with menial tasks

Posted on 22. Apr, 2014 by in Physician, Primary care

I’m no economist.  In fact I have never taken any business or accounting classes in my life.  But it doesn’t take a formal education to get this.  We are speeding down the wrong path. The call at three in the morning woke me from a deep sleep.  I fumbled and strained to hear the whispered [...]

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Where are we losing America’s future primary care physicians?

Posted on 22. Apr, 2014 by in Education, Medical school, Primary care

I know where America’s future primary care physicians are, and more importantly, where we are losing them. I am one of them, and I almost got lost. Maybe I was naïve. I’d had no math or science classes as an undergraduate, and I’d never really thought about the mechanics of medical education. Even while jumping [...]

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7 steps to eliminating the war analogy in cancer care

Posted on 22. Apr, 2014 by in Cancer, conditions

From a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything [...]

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How a hospice model can save American health care

Posted on 22. Apr, 2014 by in Palliative care, Policy

America is one of the sickest places on earth.  We have the best diabetic care, but the most diabetes.  First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease.  We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we [...]

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How to fix the problem of patient handoffs

Posted on 22. Apr, 2014 by in Hospital, Physician, Residency

One of my biggest pet peeves is taking over the care of a floor full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work [...]

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There are no quick fixes to hospital-acquired infections

Posted on 22. Apr, 2014 by in Hospital, Policy

Recently, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging. First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients died during [...]

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Top stories in health and medicine, April 22, 2014

Posted on 22. Apr, 2014 by in Cancer, heart, Nephrology, News

From MedPage Today: Sudden Cardiac Death Robs Many Years of Life. The burden of sudden cardiac death in terms of years of potential life lost is high compared with other leading causes of death in the U.S. HTN Guidance Takes Center Stage at NKF. Guidelines on hypertension management, particularly the JNC8 recommendations released last December, will [...]

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Monday afternoon

Posted on 22. Apr, 2014 by in Uncategorized

I had a nice elderly couple in. She had mild-moderate dementia, and I was looking over her previous test results.Dr. Grumpy: “It looks like your internist did a pretty decent work-up. Unfortunately, I have to agree with him that she has Alzheimer’s dis…

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My experience at Malpani Infertility Clinic

Posted on 21. Apr, 2014 by in Aniruddha Malpani, Anjali, Clinic, In vitro fertilisation, Infertility, Lizzy, Malpani, Mumbai

I have done 3 IVFs with a leading IVF clinic in south Mumbai ( with Dr X ) and 1 with Dr. Anjali & Aniruddha Malpani. Dr. Malpani is without a doubt the place to go for your IVF treatment.Here’s a comparison of my personal experience with both doct…

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Think

Posted on 21. Apr, 2014 by in Uncategorized

For those of you who haven’t seen it, this excellent piece was on KevinMD today.For those of you who don’t believe this is what American medicine has come to… you should. I’ve felt the same things other docs have more times than I can count.For those…

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Measles and the media: Are parents are being duped?

Posted on 21. Apr, 2014 by in conditions, Infectious disease, Pediatrics

Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell. Continue reading [...]

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Avaz Raises $550K In Seed To Help Autistic Children Communicate Using Visual Tools

Posted on 21. Apr, 2014 by in Uncategorized

As a member of Mumbai Angels, I am very pleased to be on the Board of Avaz , which has  just raised US 550K  . Avaz helps autistic children to communicate using an iPad app. Ajit is one of the smartest and most driven entrepreneurs I have met…

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How to come to terms with wanton cruelty

Posted on 21. Apr, 2014 by in Uncategorized

A friend whose mother was murdered in Kabul, Afghanistan last month teaches us a lesson in how to come to terms with wanton cruelty.   If you feel inclined to support her family’s non-profit organization in support of education and service op…

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Look, you can watch this happen in real time!

Posted on 21. Apr, 2014 by in Uncategorized

Those of you who had any doubt at all about the points I raised in my recent post about how the daVinci robot system has extracted funds from the health care system, check out this story by Jaimy Lee and Harris Meyer on Modern Healthcare, “Surgical Rob…

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Weekend on call

Posted on 21. Apr, 2014 by in Uncategorized

This past Saturday morning I was dragged in kicking and screaming consulted at the hospital to see an elderly gentleman. He’d fainted while playing bingo at the Mishwauketomee casino the previous night.Dr. Grumpy: “What happened, sir?”Mr. Bingo: “I jus…

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The smoke and mirrors behind HLA matching and NK cells activity assay – the “reason” and “cure” for unexplained implantation failure!

Posted on 20. Apr, 2014 by in Cytotoxic T cell, HLA, Human leukocyte antigen, Major histocompatibility complex, MHC, MHC class II, Natural killer cell, Organ transplantation

This is a guest post from our expert patient, Manju. She is a scientist, and this post will help you to debunk some of the myths and misconceptions surrounding “immunological implantation dysfunction”. This is a complex topic, which most IVF specialist…

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I, Robot has nothing on the truth

Posted on 20. Apr, 2014 by in Uncategorized

Here’s the IMDb summary of the 2004 movie I, Robot:In the year 2035 a techno-phobic cop investigates a crime that may have been perpetrated by a robot, which leads to a larger threat to humanity. But we don’t have to wait until 2035.  We’ve seen a…

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Choosing Wisely – A Guide for Patients Five Medical Facts You Need to Know About Hormone ( Endocrine) Disorders

Posted on 19. Apr, 2014 by in ABIM Foundation, Conditions and Diseases, Diabetes mellitus type 2, Endocrine Society, Health, Thyroid, Thyroid-stimulating hormone, United States

We are seeing  a major epidemic of avoidable care today. Unnecessary tests and expensive treatments have become a major health hazard. What can  you do to protect yourself ?An initiative of the ABIM Foundation, Choosing Wisely is focused on e…

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Addressing the structural forces that perpetuate inequality

Posted on 19. Apr, 2014 by in Physician, Primary care

I recently published an article on that garnered a lot of attention. It was titled,”The Myth of the Entitled Single Mother Remains as Relevant as Ever.” In it, I reversed the popularized notion that single mothers are a societal liability and suggested that instead, they are powerful forces in our local economies and influential leaders [...]

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7 ways chronic illness imposes an extra burden on the young

Posted on 19. Apr, 2014 by in patient, Patients

From years of writing about chronic pain and illness, I’ve learned that young people carry several extra burdens, especially when their disability is invisible (as is more often the case than not). This piece focuses on young people, although some of its points apply to people of any age, depending on their circumstances. 1. Young [...]

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