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How Practices Should Deal With Late Patients


Most medical practices have policies about no-show patients, but does your practice have a clear protocol for patients who show up late to appointments? How about the chronically late patients for whom tardiness has come to be expected?

A tardy patient can easily derail a practice’s whole schedule. Especially in small practices where there is less coverage, one late patient can affect the amount of time all patients receive that day. Do you accommodate the patient? Turn him away? What are the effects of either option?

There can be major liability issues with refusing to see a late patient outright. “It can be downright unethical,” states Torrieri. It is recommended to discuss this with your malpractice carrier. Unfortunately, if a medical emergency were to occur as your late patient is asked to leave your office, you can be held responsible.

The right thing to do is try to accommodate the patient. First, be sure that your practice is running on time before penalizing a patient for being late. "If you're five minutes late, everyone is five minutes late," cites the article. If another clinician is available, fit the patient into her schedule instead. If there is no available coverage, let the patient know the approximate length of time until he can be seen.

For chronic lateness, you may decide to dismiss the patient from your care if the behavior is addressed and does not change. Here is an example from the article on an escalating tardiness policy:

At Performance Pediatrics in Plymouth, Mass., late patients — those who are more than five minutes late — are treated the same as no-show patients. On the first and second offenses, they're sent a warning letter. On the third offense, they're told they will be dismissed if the problem continues. And on the fourth offense, they are asked to find another provider.

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1 week to IM Boards. Are you ready?


IM Boards start on August 6, 2013. Have you done everything you can to prepare?
Introducing: Smartest Doc Board Exam Prep

Prepare for your upcoming Board Exam with multiple-choice, board-style questions available for free as another MDLinx Member Perk!
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Prepare for your Medical Boards with MDLinx



Introducing: Smartest Doc Board Exam Prep

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Watch for additional Board Exam Prep courses, including Family Medicine and Oncology, coming soon!


Upcoming Key Medical Conferences: We've Got You Covered


Prepare With MDLinx Conference Center!

We’ve been listening! An overwhelming number of medical professionals have expressed their interest in a comprehensive hub for all upcoming conferences, across all medical specialties. 

With the new MDLinx Conference Center we have you covered…

Find out the Details- Location, date, time and contact information; find all the pertinent information in our all new Conference Center

Map your trip- Explore the area and plan your activities by proximity.

Prepare for this meeting- Read recently published articles related to the meeting, hand picked by the MDLinx editors. 


Upcoming Conferences

(Late July- August 2013)


2013 Society of Critical Care Medicine Study Mission to South Africa

Infectious Disease 

ICAAC 2013: 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy meeting

Emergency Medicine 

2013 Emergency Nurses Association Annual Conference 


2013 American Society for Clinical Pathology Annual Meeting


2013 American College of Clinical Pharmacology Annual Meeting


2013 American Academy of Otolaryngology - Head and Neck Surgery Annual Meeting more medical conferences

Informing DSM 5


Behind On Your Journal Reading?

Get Current in just a few minutes a day. MDLinx summarizes ranks and sorts all the best medical journal articles in 32 specialties and 800 sub-specialties from over 2000 journals daily. Check out this month’s top read Psychiatry article.

Informing DSM 5: Biological boundaries between Bipolar I, Schizoaffective, and Schizophrenia
**Available in Full Text**

► Read It Here
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Prep For Your Exams with the Smartest Doc Review Question Banks


Exams Looming? Prepare to Pass with Smartest Doc 

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Anaphylaxis: An alarming medical anomaly on the rise


Earn Category 2 CME Credit:  Click Here to Read the Full Summary on TODAY!

What should your patients know about anaphylaxis?

Anaphylaxis is the rapid onset of a severe and potentially lethal allergic reaction. Unpredictable in nature, the key identifiers for this condition are variable. While most people who experience an anaphylactic reaction have a pre-existing and known allergy to a trigger substance, a smaller fraction of those afflicted are not even aware that they have an allergy. Although the lifetime prevalence is estimated at 0.05-2%, the rate of occurrence is on the rise and even the first episode of anaphylaxis can result in fatality.

Key Components:

  • Symptom onset commonly occurs within 2 minutes to 1 hour of exposure to a specific trigger.

  • It is uncommon, but it is possible that symptoms do not develop for several hours.

  • 80- 90% of anaphylactic reactions include hives (urticarial) and swelling of the skin (angioedema).

  • Approximately 70% of reactions cause respiratory symptoms, which are more common in individuals with chronic respiratory diseases.

  • Severe anaphylaxis causes sudden collapse without other symptoms; this form occurs most commonly after a person is given a medication intravenously or is stung by an insect.

Common Symptoms:

  • EYES: Tearing, redness, itching and swelling

  • SKIN: Flushing, hives (urticaria), or swelling (angioedema)

  • HEART: Weakness, dizziness, fainting, rapid or irregular heartbeat, and low blood pressure

  • NERVOUS SYSTEM: Confusion and anxiety

  • DIGESTIVE SYSTEM: Vomiting, abdominal cramps, nausea and diarrhea

  • NOSE & MOUTH: Runny nose, sneezing, nasal congestion, swelling of the tongue and metallic taste

  • LUNG & THROAT:  Difficulty breathing, excessive coughing, chest tightness, wheezing or other sounds of labored breathing, increased mucus production, throat swelling or itching, hoarseness, change in voice and choking sensation

Who is at risk?

Some people are more likely than others to experience anaphylaxis, for example, those who have one or more of the following:

  1. Previously experienced a sudden severe allergic reaction involving the whole body

    •  Those who have had allergic reactions to a particular substance in the past are at increased risk. However, the severity of past allergic reactions does not reliably predict the severity of future reactions.

  2. Those diagnosed with asthma

    • Individuals with asthma are more likely to have severe respiratory problems during anaphylaxis. Data indicate the combination of food allergy (especially to nuts) and asthma seems to put people at increased risk for life-threatening episodes of anaphylaxis when exposed to a trigger.

  3. Those with other types of diagnoses

    • People with chronic lung disease, especially older adults with chronic obstructive pulmonary disease (COPD) or emphysema, are at increased risk of complications during an anaphylactic reaction. People with coronary artery disease and other heart diseases are also at greater risk of developing complications.

How to prevent/treat?

If patient has had an anaphylactic reaction or has suspected triggers:

  • See an allergist for evaluation and for specific training and diagnosis.

  • Seek out testing to determine the trigger; an allergist should perform skin testing at least 3-4 weeks after an anaphylactic reaction b  because if done too soon after the event, such tests may give false negative results.

  • Avoid triggers! When a trigger has been identified, the individual should be urged to stay away from the substance.

  • Always wear medical identification and carry epinephrine!

During an anaphylactic episode:

  • Call for emergency help immediately. Episodes are often times life-threatening-- it should be treated as a medical emergency.

  • Treat the person with epinephrine, those with a history of anaphylaxis should always carry an injector.

  • Place the person on their back or in a semi–reclining position with the lower extremities raised

  • During the episode, if needed, give high flow supplemental oxygen, establish intravenous access to provide high volume fluids, and perform cardiopulmonary resuscitation.

  • Go to the hospital,  after injecting epinephrine; it is important to be evaluated in a hospital emergency department. There is no reliableway to predict whether or not a late-phase reaction will occur, but up to 20% of people with anaphylaxis have a late-phase reaction and might require additional treatment.

All HCPs are encouraged to talk with their patients who have a history of these types of reactions to develop an Anaphylaxis Action Plan. Many people find having a treatment plan to respond to future reactions reassuring.


Alcohol + Energy Drinks


Maybe worse than you think


Consuming cocktails that mix alcohol with energy drinks is a growing social trend amongst socialites.  Indulging in the idea of “getting high” without getting tired is not only intriguing, but an ideal way to maximize a night of energy drinks and alcoholentertainment and excitement.  Although socially acceptable, this mixture can be detrimental both to your physical and mental health. Many researchers make claims that this activity is most common amongst adolescents; however, according to the American Journal of Drug & Alcohol Abuse there are Correlates of Concurrent Energy Drink and Alcohol Use among Socially Active Adults.


Energy drinks are not regulated by the FDA so producers are not required to disclose the caffeine content on the label.  According to Risks of Energy Drinks Mixed With Alcohol, an article recently summarized on, energy drink manufacturers are not “held accountable for claims regarding the health and psychosocial benefits of their products.”  High levels of caffeine boost the heart rate and, in combination with alcohol, can increase the risk of heart rhythm complications. The stimulation also masks signs of inebriation, such as the feeling of fatigue, which typically signals the body’s had enough to drink. 


Consequently, drinkers of these trendy cocktails are more likely to make irrational or irresponsible decisions, such as driving while intoxicated or inflicting harm on others. They are also about twice as likely to report being taken advantage of sexually, to report taking advantage of someone else sexually, and to report riding with a driver who was under the influence of alcohol.1

Not only can the mixture of alcohol with energy drinks be unhealthy, harmful to your body and impair your judgment, it also causes dehydration which worsens a hangover – and there’s nothing worse than waking up after an eventful evening with a dreadful hangover.

  1. O’Brien MC, McCoy TP, Rhode SD, Wagoner A, Wolfson M. Caffeinated cocktails; energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med 2008;15(5):453-460.

Are you killing yourself? Think Before You Indulge...


Are you killing yourself? Think Before You Indulge...

We’ve all heard it before- just one cigarette can shave 3 minutes off your life. Well, what if this formula could be applied to all of your guilty pleasures? A study published by the British Medical Journal has linked life expectancy to activities such as having a couple of drinks and even watching TV; activities that to most Americans come as second nature. Did the beers you consumed during Sunday’s Super Bowl shorten your lifespan? 

University of Cambridge statistician Professor David Spiegelhalter sought to find a way to communicate the impact of human behavior on our lifespan in a simple and effective formula. In this analysis, Spiegelhalter further expands on the concept of aging slower/ faster, first introduced through the study of cigarettes on life expectancy more than a decade ago. He explicitly expresses the effect of our daily lifestyle habits as half hours of life expectancy or “microlives.” Through the use of population studies he was able to deduce that on average over a lifetime habit of behavior, that smoking two cigarettes or being 10 pounds overweight, or even watching two hours of TV, equates to the loss of a “microlife.” The idea that watching the Ravens win the Super Bowl could have cost you thirty minutes of your life is alarming to most, considering the inherent concern most humans have with their own mortality.

However, Spiegelhalter’s “microlife”  formula isn’t just a penalty system for life’s indulgences. In contrast, Spiegelhalter says, each day of positive behavior such as exercising or sticking to just one alcoholic beverage will help you gain “microlives” at an even faster rate. He cites that this positive behavior can add up to two hours to your life.

But before you start tracking your behavior and counting “microlives” as if they were calories, read Spiegelhalter’s entire explanation of the concept. He explains that this formula for life expectancy is not definitive but based on a number of assumptions, and should be treated as an approximation. The crux of his article supports the old adage, “Everything in moderation.” 

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In Spiegelhalter’s words: "Of course, evaluation studies would be needed to quantify any effect on behavior, but one does not need a study to conclude that people do not generally like the idea of getting older faster."






 Read Full Article




Sexual Dysfunction and Diabetes


Is there a correlation?


Diabetic nerve damage and blood vessel damage resulting from high blood sugar can lead to sexual dysfunction in both men and women.  Many medical professional modiabetes managementst often associate sexual dysfunction and diabetes with erectile dysfunction/ impotence, but the problem quite often persist in women as well.  Although there are many other factors that play a role in sexual dysfunction, studies have shown a direct correlation between diabetic men and women and sexual dysfunction.  The blood vessels damaged by diabetes control erection in men and the nerves damaged by diabetes prevent women from achieving an orgasm. 


According to an article found on, published in The Journal ofSexual Medicine, female sexual dysfunction is more frequent in diabetic women.  Women may experience symptoms such as: lack of interest in sexual relations, no sensation in the genital area, or pain and discomfort during sex due to dryness in the vaginal area. 


On average more than 50% of diabetic men over age 50 and 90% of men over age 70 will experience a degree of erectile dysfunction or impotence. 

Although this is a serious issue that many diabetics are forced to cope with, there are many ways to help reduce the risk of sexual dysfunction.  Always check with your doctor for the safest options. 


Tips to lower you risk of sexual dysfunction

  • Control blood glucose, blood pressure and cholesterol levels
  • Exercise or engage in some type of physical activity that helps maintain healthy weight
  • If you are a smoker, QUIT
  • Vacuum constriction devices (VCDs)
  • Ask your doctor about other treatment options, such as Cialis


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