Patient-centered Medical Home Fails to Deliver Quality Improvement

In what is sure to be a setback to the PCMH movement, a new study showed that the PCMH model failed to deliver promised quality improvements.

One of the first, largest, and longest-running multipayer trials of patient-centered medical home medical practices in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department, or ambulatory care services or total costs of care over three years, according to a study. The patient-centered medical home is a team-based model of primary care practice intended to improve the quality, efficiency, and patient experience of care. Professional associations, payers, policy makers, and other stakeholders have advocated for the patient-centered medical home model.”

Today’s MRI: Posterior Reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) (also known as hypertensive encephalopathy) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. Hyperperfusion with resultant disruption of the blood brain barrier results in vasogenic oedema, but no infarction, most commonly in the parieto-occipital regions.

It should not be confused with chronic hypertensive encephalopathy (aka hypertensive microangiopathy) which results in microhemorrhages in the basal ganglia, pons and cerebellum.

Learn more at


Imaging Signs – The Continuous Diaphragm Sign

The CXR below shows central sub-diaphragmatic lucency (continuous diaphragm sign) in keeping with pneumoperitoneum.

Continuous Diaphragm Sign

Robin Williams Tribute

The Primary Care Clinic at Stony Brook held a tribute lunch to Robin Williams on 8/12/2014. Robin Williams committed suicide on 8/11/2014 after a long battle with depression. He brought joy to millions through his acting, comedy, and generosity, and he was “one of a kind” as President Obama put it.

Remember that depression can strike anyone. Someone may be depressed and yet never show it or talk about it. They can seem to have everything, and yet feel they have nothing.

“Richard Cory” by Edwin Arlington Robinson

Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean favored, and imperially slim.

And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
‘Good-morning,’ and he glittered when he walked.

And he was rich – yes, richer than a king –
And admirably schooled in every grace:
In fine, we thought that he was everything
To make us wish that we were in his place.

So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head.


Robin Williams Tribute

IBM’s new chip – a silicon brain

While not strictly medicine, this technology has vast implications for health care. Real-time artificial intelligence analysis of lab and clinical data will become a reality.

“The chip, or processor, is named TrueNorth and was developed by researchers at IBM and detailed in an article published on Thursday in the journal Science. It tries to mimic the way brains recognize patterns, relying on densely interconnected webs of transistors similar to the brain’s neural networks.

“The TrueNorth chip is like the first transistor,” said Terrence J. Sejnowski, director of the Salk Institute’s Computational Neurobiology Laboratory.

Approaching the End

While doctors primarily pursue medicine with the intention of healing people and curing disease, little do they realize how much death and dying becomes part of the conversation with patients and families. Throughout my internship year in internal medicine, I was faced with many discussions regarding palliative care. Discussing the end of life is not an easy task at any stage of a physician’s career, from seasoned physicians to novice interns

Check out the full article:

Journal of Medical Education Perspectives
Vol 3, No 1 (2014)
Table of

Brooklyn Half Marathon Medical Team Volunteering

Hey guys,

Stony Brook Medicine will be participating in the Brooklyn Half Marathon on May 17, 2014 as medical volunteers. Let me know if you are interested in volunteering as a medical personnel.


Also, keep a look out for more details for the NYC Marathon in November 2014!

For more information on the Brooklyn Half Marathon:


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