Saturday, January 30, 2010
The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I'm sure you have seen some of these: U.S. World & News Reports, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals. My local magazine lists the "top doctors" along with full page paid ads and promos that are very compelling. The questions is, do consumers care? Are these rating agencies really steering people toward top quality in health care?
Each of these agencies and organizations that "rate" have different measurements and criteria for their choices. The top rankings do not necessarily relate to quality outcomes. The Medicare data are two years old. Different treatments and conditions are judged, so a "top" hospital in one area may be a loser in another.
Even the mortality rates for acute myocardial infraction (heart attack) that were in the top 50 hospitals in US News & World Reports were misleading . One third of the ranked hospitals were outside the best performing quartile based on mortality and 4 of them were within the worst performing quartile.
Where can a patient go to find out the outcomes of a hip replacement? What if I want to know the infection rate and the number of hips that require "re-do"? How can I find out information about my surgeon? How many has he/she done? Do they track outcomes one year after surgery?
Believe me, you cannot get this information. Period.
Patients are becoming more savey about health care choices but research suggests that rankings have little influence over those choices. "The primary care physician is still the leading source for patients seeing specialist physicians and the opinions of referring physicians remain the leading factor for an individual patient choosing a hospital", according to a JAMA perspective article.
For that reason it is important that patients have a choice and have transparent information on their primary care physician. Selecting a physician is done mainly by "word of mouth" and availability. The consumer websites where patients can rate doctors are imperfect, but without better ways to get information, more patients are looking there as they select a doctor.
We still don't know if the 5 star doctors are just nicer or if they are clinically better.
Wednesday, January 27, 2010
It is always great when medical research supports the common sense that grandma knew decades ago. A study published in the Archives of Internal Medicine show that poor sleep increases our susceptibility to the common cold.
The researchers studied men and women ages 21-55 and monitored their sleep duration and efficiency (amount of time in bed actually sleeping) for 14 days. They then quarantined them and gave them nasal drops of rhinovirus (one of the common cold viruses) and monitored if they got a cold.
What did they find in this elegant experiment?
The subjects who slept 7 hours or less were almost 3X as likely to develop a cold than those with 8 hours or more of sleep. They looked at pre-test virus specific antibody titers, demographics, season of the year, body mass, socioeconomic status, health practices and psychological variables. None of those factor played a role in who caught the virus.
It is also interesting that 83% of the subjects were infected (blood tests showed increased viral titers) but only 35.3% showed infection plus cold symptoms. Patients with lower sleep efficiency had more severe cold symptoms.
These results suggest that better, longer sleep helps the body's immune system fight off symptoms of a cold since more patients got infected than got symptoms.
It also points to the fact that we are all probably exposed to viruses all the time, but some people seem to "catch" them more readily. Wash your hands and get more sleep to boost immunity.
Thank you to all the followers and commenters and readers. Please let me know if there are subjects you would like explored.
Tuesday, January 26, 2010
New research shows that money makes people happy and if someone is paid by the hour they are even happier. This strange study was done by Jeffrey Pfeffer at the Stanford Graduate School of Business and Sanford DeVoe of the University of Toronto. They studied both British and Americans who were paid hourly vs. salary wages and compared their general happiness. The surveys showed that pay determines the happiness of hourly workers more than it does for people paid a salary.
Pfeffer said that the study showed people who are paid by the hour think differently about money, time and happiness. They think about their income regularly and begin comparing the value of their time to the amount of their happiness.
I find this study rather strange. It was published in the Personality and Social Psychology Bulletin and I haven't read the entire study but there may be other variables that interfered with the conclusion about hourly pay and happiness.
Most low income people are paid by the hour. Are they really happier than the banking moguls who are getting $million dollar bonuses? Do people who work for minimum wage report they are "satisfied with their life" at a higher rate than salaried people? The study says yes.
I think this is a study that needs to be validated.
Sunday, January 24, 2010
Photo credit to Operation Rainbow, Photographer Mike Lee.
Instead of writing a blog for EverythingHealth today, I am linking readers to the Sutter Helps Haiti blog that I have been writing. The medical volunteers that are on the ground make for interesting writing and reading. The medical issues that victims of the earthquake are facing will change as the days go on.
The initial amputations for crush injuries are about over...now broken bones are being pinned with good orthopedic equipment and skilled surgeons. The problems with infections persist and the aftercare for patients will be prolonged. It takes about 6 months for an amputee to learn to cope and the only prosthetic manufacturer in Haiti was destroyed in the earthquake. Prosthetics and physical therapy will need to be imported.
The fact that many patients have no homes or family to care for them is the biggest issue medics face now. The medics are serving as family and shelter at this time for thousands of people.
This story will be with us for a long time.
Friday, January 22, 2010
Photo credit to Operation Rainbow, Photographer Mike Lee
No One knows what the death count in Haiti is. Whenever they start estimating "fifty to a hundred thousand", you know it is just a guess. But the number is huge. Entire schools, office buildings and hotels collapsed, crushing the people inside. Tens of thousands of people were injured and they are flooding the makeshift medical tents and hospitals in surrounding areas.
I staffed a medical site at Katrina. The problems there were fairly routine because the people had simple injuries and were mainly displaced and in shock. Hospitals were functioning in Baton Rouge and we had access to medication and supplies. That is not the case in Haiti.
The initial wave of victims had crush injuries and compound fractures where the bones were split and sticking out through the skin. Without X-ray equipment or orthopedic pins and bolts the only treatment is a makeshift splint or amputation. Dressings were hastily applied and the medics went on to the next one. There were thousands of patients waiting to be seen. Those early patients now have gangrene in the wounds. Some of the more serious have a condition called rhabdomyolysis where muscle chemicals are released and cause renal failure. Without IV fluids and dialysis, the patient often dies.
I heard from a doctor volunteer this morning that there are now enough medical teams, but the lack of operating rooms and equipment is still critical. University Hospital in Port au Prince has temporary operating rooms going 24 hours a day but they still lack modern anesthesia, imaging and surgical tools. The last time this many amputations were done was during the Civil War. When a leg is crushed and infected, that is all that can be done to save the patient...maybe.
The USN Comfort floating ship hospital has arrived and has capacity for 1000 people. The most serious cases are being shuttled out to the Comfort. The ship has resources and modern equipment that has never been seen in Haiti. A U.S. Disaster Medical Assistance Team (DMAT) is now set up in the city and it is also well equipped but there is no way to let other areas know it is up and running.
Think of your own city. You may know what is going on within a few blocks, but without communication how would you know what is available 3 miles away? What if you are homeless and hungry and injured? A coordinated crisis would have medics traveling with the U.N. trucks and transporting the injured. The thousands of volunteers should be deployed in meaningful ways to deliver supplies, triage the sick and transport back and forth.
The problem in Haiti now is not lack of medical volunteers. The problem is coordination. I hope the world can learn from this crisis and do it better next time.
Wednesday, January 20, 2010
As the coordinator of Haiti Medical Relief for my generous employer, I find myself in contact with numerous organizations that are providing relief in Haiti. Our 15 person surgical team is being deployed today to Port au Prince. The fact that one week after the earthquake, relief is still spotty and millions of people are still without basic food and water is shocking to many of us following the disaster.
Katrina and other hurricanes and earthquakes worldwide were a major crisis...but victims were evacuated and many were able to return home after the crisis ended. In Haiti, the entire city of Port au Prince and surrounding cities were completely leveled. No-one can return home and most of the population is displaced and on the street. The entire government was also leveled with files, data, banks, stores. Many of the government employees are either dead, or seeking out their own relatives.
The Port to move in supplies was destroyed (although is now opening) and the airport has one runway and no control tower. Without a functioning government, communication to victims and relief workers is absent. The best communication has come from the press (CNN, BBC)email and twitter.
I wonder how Iceland arrived so quickly. Their search and rescue team was first on the ground. With any disaster of this type, search and rescue is the first responder. It has now been past a week and search and rescue will turn into search and recovery (of bodies).
It appears that there are now enough troops on the ground to control the situation and deliver aide. What is needed is a central command. The U.N has proven they are not up to the task in my opinion. The U.S. military has the infrastructure and, in cooperation with other nations, could take over leading that effort. Tent cities with santitary facilities need to be constructed immediately and the Red Cross should be empowered to run the food distribution. I was gratified to learn that there is already an employment mechanism to put Haitians to work clearing rubble and delivering supplies.
The Haiti Earthquake is already fading in the minds of the public. It is no longer front page news and CNN is showing only snippets of it now. Yet one week after the disaster, they are still performing amputations using generators for power and are performing 20,000 operations a day at University Hospital with makeshift tent operating rooms.
I will report on the medical relief in my next blog.
Tuesday, January 19, 2010
The newest media Doc on the block is Dr. Mehmet Oz. When he was first seen on Oprah, he seemed engaging and answered some interesting questions in a real and professional way. The audience loved his blue scrubs and boyish clean cut open style.
That was then.
Let's face it...the media spotlight seems to corrupt even the best physicians. Dr. Oz now has his own show and website and production company. That is a pretty big infrastructure to maintain and we know that the public is fickle. So what does he do?
His "Real-Age" website got 27 million people to sign up and take a health quiz. That information was sold to pharmaceutical companies who used the direct emails for marketing. Real-Age also sends the participants a series of emails about conditions they may (or may not) have and drugs they can use to treat it, based on their answers to the on-line health quiz, sponsored by drug companies of course.
He does pieces on "men's health" and tells men to do male breast checks once a month. No research I have read would support this advice. On his website he says "By the time women reach their 20th birthday, they are at risk for developing osteoporosis". Really? An upcoming show asks "Can you climax from intercourse?" Gee, is this a health question that needs an answer by an expert?
With his busy production schedule, book tour and daily talk show on Sirius XM radio, can Dr. Oz be spending much time as the director of the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital? Do you think I could get an appointment with him?
His website shows how I can be on the show. Maybe that is how patients get their questions answered. I know I could get tickets for the show and find out if I am"Getting old too fast" (Yes!) or "Do your parents need to lose weight". (No!)
His website deals with topics like "What his erection is telling you" and "Dangerous health secrets men keep". Could what his erection is telling you be a dangerous health secret?
Enough Dr. Oz. Please stop embarrassing our profession. See a patient with atrial fibrillation and do something important with your skills.
Dr. Oz, why the goofy business shoes with scrubs?
Monday, January 18, 2010
Sunday, January 17, 2010
Saturday, January 16, 2010
Local residents were trying to dig out the child who was crying under the rubble. She had been buried there for almost three days without any food or water. It was Deiby Celestino, [of the television crew's security detail], who pulled her out of the rubble. He then passed the child to Australian journalist Mike Amor. [...]
Winnie’s uncle, Frantz Tilin, arrived to find her after losing his own pregnant wife in the earthquake. Workers with Save the Children fed Winnie and gave her fresh water to drink. The charity’s doctors said she was dehydrated, but expected her to make a full recovery.
Friday, January 15, 2010
I am so frustrated about the disaster in Haiti and have been actively engaged in relief efforts for the past 60 hours. I have been asked to lead the efforts for helping Haiti for my employer, a large hospital provider of health care in Northern California. I am proud to say that within the first 72 hours, Sutter Health has committed $1 million to Doctors with-out Borders and $250K to MedShare to get needed medical supplies to Haiti. Both organizations are on the ground providing this help right now and we chose them as partners because they can get the job done.
Getting needed professional help to Haiti is another story. The outpouring of volunteers wanting to help is huge. Our employees and doctors, nurses, engineers and computer experts are ready and willing to volunteer. But at this time the destroyed infrastructure makes sending this needed help impossible.
I know from my experience on the ground at Katrina that volunteers cannot just "show up". Volunteers need food, housing, transportation, meaningful deployment to areas of need. It stresses an already fragile system to have well-meaning people just milling about. What was lacking at Katrina is even more absent in Haiti...a well coordinated relief effort.
The situation in Haiti is much more dire than other disasters because Port au Prince was the capital and there is no functioning government. The port is closed and the airport is now under U.S. military guidance. That is a good start but bringing volunteers in by plane is impossible. They have no fuel for planes on the ground and no control tower.
I will spend the weekend continuing to investigate partnerships in Haiti. I have been in contact with a number of Haitian physicians and hospitals that are overflowing with patients. They need the help that we can provide, especially surgical teams. The logistics are a challenge.
Head on over to Medgadget to see the nominees and categories for Best Medical Blog Awards. I am happy to report that EverythingHealth has been nominated. I don't know how the winner is picked but if you scroll down on the site you can "nominate here" and maybe it is done by the most comments posted. The competition is stiff but it would be cool to win. All the of various nominees are great and it is a good way to find other blogs.
The answer to yesterdays Medical Challenge is #3: Ostraceous psoriasis. That was a stumper, but some of you got it. Of course, the dermatologist knew!
Psoriasis can present with many different appearances. It is a common, recurrent immune mediated disease of the skin and joints. It is found worldwide and has a strong genetic component. The scaling papules and plaques are circular with grey or silvery-white appearance. They usually appear on the scalp, elbows, knees,lumbosacral area and in body folds. The term Ostraceous psoriasis refers to the thickened plaques that have concave centers similar in shape to oyster shells.
Psoriasis is not contagious.
Thursday, January 14, 2010
I like to gross out the readers of EverythingHealth and today's medical challenge should do just that. In the interest of full disclosure...this is the first diagnosis I have personally missed in this challenge series from NEJM.
What is your diagnosis?
1. Lichen planus
2. Mycosis fungoides
3. Ostraceous psoriasis
4. Paraneoplastic phemphigoid
5, Staph scalded skin syndrome
Make your diagnosis (click the image for a better view) and the answer will be posted tomorrow.
Wednesday, January 13, 2010
Dr. Atul Gawande is one of the best physician writers of this decade. A Cancer Surgeon at Harvard Medical School, he also writes for The New Yorker and has written two best selling books, Complications and Better. Now he is on the speaking tour for his new book, The Checklist Manifesto: How to Get Things Right, and I heard him speak last night. This guy is a great speaker and he makes his case clearly and with anecdotal stories that bring it home to the listener.
Gawande knows that medicine has become so complex that there are thousands of tiny steps and decisions that come together to create a good patient outcome. There are also a thousand ways things can go wrong.
I think of the knee surgery I just had. If one nurse or physical therapist didn't wash their hands before they touched me, I could have gotten an infection that would destroy the surgery. If I didn't get my intraop antibiotic before the incision, that is another way to get infected. If the anticoagulant wasn't ordered, I could have a deep venous thrombosis (a common and known complication). If my dressing was too tight, I could have had a skin ulcer that would delay recovery. All caregivers want to do the right thing...but as Gawande says; "We miss stuff because of the complexity of care".
Gawande and a team of researchers copied the airline industry and brought simple checklists into the operating room to navigate complex procedures. The surgical checklist creates a pre-op "time out" for the surgical team and a way for everyone to communicate verbally the details of the case so they are on the same page. Are antibiotics given? Check! How much blood is expected to be lost? Check! Are there any equipment issues? Check!
It sounds simple but there is significant push back from some surgeons for using a simple checklist. They say it makes no difference. It causes unnecessary delays. It is worthless and just another administrative hassle. Yet institutions that use the checklist show a significant drop in complications and better outcomes for patients.
Gawande made the point that health care reform is a way of organizing and paying for health care. But the real advances we make in patient care going forward will depend upon bringing caregivers together to deliver care in organized ways with the emphasis on patient outcome...not just on what we doctors are doing at that moment.
The surgeon constructed my new knee perfectly...but the entire operation could have been a failure if everything that should have happened post-op, didn't happen. Medicine is a team sport and team sports have game plans and everyone knows their role. Atul Gawande is spreading the message.
Tuesday, January 12, 2010
Medicare policies are followed by most private insurance companies. Medicare sets the standard in what is covered and in payment rates. Currently, preventive health services are not adequately covered. Currently, some tests and treatments that are not proven to improve health ARE covered. Health Care Reform is our chance to put policies in place that will invest in preventive care that works to improve quality of life and eliminate things that do not work.
The Center for Medicare Services (CMS) authorizes 14 services that are given an "A" or "B" rating by the US Preventive Services Task Force (USPSTF). (This was the impartial task force that created the bruhaha about eliminating screening mammograms for women age 40 last month.) These screenings include: high blood pressure, mammogram, pap tests, colon cancer screen, lipid testing, osteoporosis testing and diabetes screening if at risk.
Medicare will pay for a colonoscopy or cholesterol test or mammogram. The primary care physician who coordinates the testing, encourages the tests, gives the feedback explanation and counseling for these tests receives no payment. It is a significant amount of work for the physician and her office staff , to ensure patients receive this care, but that work is not reimbursed. Only the "procedure" is reimbursed.
What else is not covered? They pay nothing for counseling for obesity and diet, despite it being one of the largest health problems facing Americans. Although there are proposals for a "Medical Home", where nurses and dietitians are involved in patient care and counseling, there seems to be no payment mechanism to cover these services.
I am not campaigning for more expense to be added to the bankrupt Medicare Bank. Some of the screening they pay for now are not value added to anyone. We have evidence that doing pap tests in monogamous women over age 70 does not improve longevity. EKGs in patients who are low risk for cardiovascular disease does not make any difference in outcome. Colon Cancer Screening in patients over age 85 is not meaningful for longevity. Prostate screening tests in elderly men increases costs and disability without any survival benefit.
Primary Care Physicians lack any incentive to use evidence to make decisions and coordinate real care for patients. We do it without payment because it is the "right" thing to do and because it is part of our job. We will not reap the benefits of Health Care Reform until we really tackle the issues of reimbursement, value, and the "guts" to say no to procedures that are of no use.
(Credit given to Dr. Lesser and Robert Woods Johnson Foundation for info used in this blog)
Sunday, January 10, 2010
I can't tell you the number of times women in their mid 40's come to me and announce "Well, I'm ready to get pregnant". Putting off pregnancy is understandable in our times. Women are building their careers, moving and traveling, going through a series of "Mr. Wrongs" and looking for the best baby-daddy. Women have thought that fertility was a given and they could get pregnant when the time was right. But, sadly, what they haven't been told is the cruel trick of nature. Fertility doctors know...after age 29 your chance of having a baby without medical treatment is diminishing every year. After age 40 there is a precipitous drop.
To bring that fact home, check this out. A woman age 19-26 has a 50% chance of getting pregnant during any one menstrual cycle if she has intercourse two days prior to ovulation. For women age 27-34 the chance was 40% and after age 35 it drops to 30%. And at 40 you are only 1/2 as fertile as you were at 35. That is a sharp drop off!
Why does fertility decline with age? There are a number of reasons that compound each other:
- Eggs- The number of egg follicles left in the ovaries declines with age and no new ones are made.
- Menstrual cycle - as women age the cycle can become irregular and shorter.
- Lining of the womb - the endometrium is thinner and less hospitable to a fertilized egg.
- Mucus secretions - the vaginal secretions can be less hospitable to sperm.
- Other diseases - endometriosis, chlamydia and polycystic ovary syndrome(PCOS) can play a role in preventing pregnancy.
Advanced fertility treatment can help many older women become pregnant. The average cost of an in-vitro fertilization (IVF) cycle in the U.S. is $12,400. That is after a complete (expensive) hormonal workup and exam. For women over age 40, fewer than 1 in 12 cycles results in a pregnancy. If a woman over age 40 is able the have a baby, the medical cost per delivery is $132,000. About 11% of IVF pregnancies end in miscarriage. Very few women over age 43 will attempt IVF and very few clinics will even offer it.
Bottom line is IVF cannot reverse aging. The number and quality of eggs remaining is the major factor in women over age 40 getting pregnant and IVF cannot change those factors.
For women over age 40 who have wanted to have children , these facts are a slap in the face. Doctors have talked about birth control for years but few doctors gave the information about fertility and women say "Why didn't I know this?"
And what about those movie stars who are in late 40's having babies? It is not their egg, or they are using a surrogate or they are adopting. Period.
Friday, January 8, 2010
The answer to yesterdays Medical Challenge was..you guess it...frostbite. Frostbite occurs when tissue is exposed to temperatures below the freezing point of skin. It can happen to anyone, even those acclimated to cold climate. As the body gets colder and colder the blood vessels in the extremities constrict to send more blood to vital organs. That is why fingers, toes, noses and ears are so susceptible to frostbite. Deep frostbite causes swelling and blood-filled blisters. Clear blisters with intact sensation have a better prognosis than blisters with dark fluid.
The amount of final tissue destruction is proportional to the time it remains frozen. Rapid transport to a hospital is important for supervised warming. A water bath heated to 104-107.6F is best for rapid thawing. This can be very painful and dehydration is possible so IV fluids may be needed to treat hypothermia.
It's cold out there so bundle up, wear hats, gloves and heavy socks.
Thursday, January 7, 2010
Wednesday, January 6, 2010
Obesity is a significant medical condition. We know that fad diets do not work. Quick weight loss schemes are ineffective at keeping weight off. Bariatric surgery is one of the fastest growing elective surgeries in the U.S. This person could lose significant weight if she restricted all white, processed foods including sugar.
This photo says it all.
Tuesday, January 5, 2010
Medicare, the government insurance company for everyone over age 65 (and for the disabled) pays fees to primary care physicians that guarantee bankruptcy. Additionally, 70% of hospitals in the United States lose money on Medicare patients. That's right...for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary care physician visits. Mayo gets it. Nationwide, physicians are paid 20% less from Medicare than from private payers. If you are not paid a sustainable amount, you can't make it up in volume. It just doesn't pencil out.
Mayo lost $840 million last year on Medicare. Since Mayo is considered a national model for efficient health care, if they are losing money it doesn't bode well for the rest of us who are much less efficient and who have fewer resources for integrated patient care. Instead of Medicare payments for clinic visits, Mayo will start charging patients a $2000 fee for patients to be seen at their Glendale, Arizona clinic. Much like a "retainer", this fee will cover an annual physical and three other doctor visits. Each patient will also be assessed a $250 annual administrative fee.
Primary Care physicians are on the front line of patient care and senior patients are the most time consuming. The average Medicare patient takes 11 different medications. Just refilling and coordinating the medication can take up an entire office visit, without addressing other health concerns. I grant all Medicare patients a 1/2 hour visit because I would be chronically behind if I didn't. After paying office overhead, I am broke with Medicare. I do not welcome the 65th birthday of my patients, but I continue to see them because I love my Senior patients. No kidding, I really love being their doctor. They are grateful and respectful and have interesting health conditions. I am able to see them because I make my income from my administrative position and I have private pay patients.
Sad but true. Unless we have true payment reform that values primary care and pays for coordination of care, I fear Medicare patients will not find enough willing physicians who accept Medicare in the future.
Sunday, January 3, 2010
Saturday, January 2, 2010
With over 670,000 published medical studies each year, doctors and patients have information overload. That's where EverythingHealth comes in. We keep up with the latest...so you don't have to read thousands of medical journals. It is as important to know what doesn't work, as it is to know what does. Save your money and save your body from unnecessary surgery. From 2009, here are a few bits of info you might find interesting:
- Ginkgo Biloba- doesn't improve memory or cognitive function. A very well done study, published in JAMA, finally puts this supplement to rest. The herb is ineffective in slowing down decline in thinking associated with aging.
- Vertebroplasty for fractures-doesn't work better than placebo. Painful vertebral fractures of the spine have been treated with injecting a "cement" into the fracture site. Two studies this year (NEJM, Spine) showed no benefit from the procedure.
- TENS Unit for Back Pain-isn't worthwhile. The American Academy of Neurology's Therapeutics and Technology Subcommittee recently issued new guidelines, and among the pronouncements was the declaration that transcutaneous electric nerve stimulation (TENS) is not advised as a treatment for chronic low back pain that has lasted for three or more months. After scouring the literature, they could not find evidence that TENS was effective.
- Avoiding nuts, corn and popcorn if you have diverticulitis-is wrong advice. Patients with diverticulitis have been put on restrictive diets and advised to avoid nuts, corn and popcorn. There is no scientific evidence to support this. Nor do patients with diverticulitis need more screening colonsocopy that patients without.
- Fasting for Lipid tests may not be needed. Patients are instructed to get their blood tests "fasting", meaning not eating for 12 hours. But new evidence published in JAMA shows that a fasting vs. non-fasting blood sample did not matter in assessing risk for vascular disease. It will probably be quite awhile before doctors stop telling patients to fast for the blood test. It has become like a reflex.
Friday, January 1, 2010
Imagine there's no heaven
It's easy if you try
No hell below us
Above us only sky
Imagine all the people
Living for today...
Imagine there's no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace...
You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one
Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world...
You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one
Happy New Year, 2010
We all know that Emergency Departments are over-crowded with long waits and exorbitant fees. Free standing Urgent Care is a great solu...
image from myaspiebrain Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient...
The newest media Doc on the block is Dr. Mehmet Oz. When he was first seen on Oprah, he seemed engaging and answered some interesting que...