“When companies start unbundling costs, it is a sign of increasing consumer power and weakening market power.” This is what CEO David Goldhill and author of Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong told me once. Airlines have unbundled everything that used to be included in a plane ticket. No longer do tickets include meals, in-flight entertainment, and the ability to check in baggage. Today, ...

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“Afternoon,” the doctor says. “What brings you here today?” A cough? A cold? A belly ache? Some feelings of dismay? Well, tell me just what ails you, and I’ll try to do my best, To sort through all your problems and put your fears to rest. But give me just a moment -- my computer must get started. Without attention to its needs, your visit goes uncharted. You say your chest is hurting? And you’re really ...

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On an ordinary day last month, I saw patients for eight and a half hours. I addressed a dozen computer messages, took four or five calls from outside providers and held innumerable curbside conversations with medical assistants, case managers and colleagues. I didn’t get to any of the 100+ lab results or 50+ documents in my electronic inboxes. Consequently, the care for several dozens of my patients didn’t move forward. Many of ...

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Making health care more patient-centered is rightly on the agenda for all hospital administrations across the United States. The need to give our patients the best "service" possible has also been pushed to the forefront as a result of reimbursement models which place more of an emphasis on patient satisfaction. Unfortunately, this has led to some in the hospital industry making comparisons with hotels, and how hospitals can take lessons from ...

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Coughing is one of the most common reasons parents bring their children to see me. And I can understand why. Coughing is noisy and uncomfortable and gets kids dirty looks in schools and subways. Even worse, coughing keeps kids and their parents awake. We’ve all been there, and no one likes to cough. But coughing is there, usually, for a reason. Almost all coughs are from upper respiratory infections (that’s fancy ...

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The Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program -- also known as meaningful use (MU) -- initially provided incentives to accelerate the adoption of electronic health records (EHRs) to meet certified program requirements.  Many physicians were mandated to change over to electronic records at the cost of tens of thousands of dollars.  Electronic records have never been shown to improve patient care or outcomes with statistical significance, ...

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From the first year of medical school, we are trained in probing into the most personal aspects of patients’ lives; but when it comes to spirituality, we shy away. In a survey of the U.S. general public, the 2008 Gallup Report demonstrated that 78 percent of people believed in God and an additional 15 percent believed in a higher power. Other studies have shown that religious beliefs and ...

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During this recent emotional and divisive election cycle, much ink was devoted to analyzing the brave new political world we now live in, a world in which just about anyone with an audience and a platform can issue statements that are accepted as fact by millions of people, often in the face of solid evidence to the contrary. I’m talking, of course, about the world of post-truth politics. Two ...

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"What do you want to be when you grow up?” It’s a common question we ask our youth, and I remember as young child sharing my aspirations with family members. When I answered "I want to be a doctor when I grow up”, I received positive feedback and praise. As an innocent little girl, I had no idea that there were people in the world who wouldn’t be as supportive of a woman in medicine. Later ...

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We are truly living in a remarkable era of biotechnological progress. Emerging nanotechnologies and immunotherapies offer the possibility of the targeted destruction of cancerous cells. 3-D printing of living cells is on the horizon, engendering the hope of a future with fully printed organs. And simultaneous advances in neuroscience and bioengineering have given rise to promising research and development of “electrocueticals” (neuromodulatory devices that may alleviate the symptoms ...

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Over the past couple of months, I have had the privilege of meeting with several colleagues in my community. When I contacted them, I offered to bring them lunch if they would give me a few minutes to share an idea about a project that I am really excited about. However, what I really wanted was a chance to engage with physicians who I knew little more than their name ...

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It’s the first day on my 4th-year elective in the emergency department. I had orientation in the morning and just my luck I am scheduled for a night shift. I had the good fortune of finding an emergency physician in New York who let me shadow him before my rotation, but the truth of the matter is, I had no idea that what I was getting myself into. I guess ...

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I was the "TV doctor" at the CBS, NBC, and ABC affiliates in Minnesota and Chicago for 25 years. I was on air several times a day and anchored my own news block. I did some good. I organized a colon cancer early detection campaign while presenting a series on the illness. One-hundred thousand viewers picked up Hemoccult tests, 25,000 sent them in, and I received a plaque that says, “Thank you for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks' gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. ...

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Slave, I am not Servant, I may be Arrogant, I am not Ignorant, I may be Un-engaged, I am not However, Quiet, I may be. Your coat is long, mine short Your knowledge mile deep, mine mile wide You have seen 100 patients this week, I have seen 10 You trained for 10 years, this is my first If I look scared, it’s because I am If I seem intimidated, I indeed am If I appear confused, I in fact am If I ...

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In high school and college, I waitressed in a Dunkin’ Donuts shop that sat between Boston Common and the Combat Zone’s porn shops, strip clubs, and bars. The wages paid for school, clothes, rent, and food. At the time, I didn't realize this job would provide useful skills for my later medical career, an early pre-med training of sorts. Look the part. I donned the bubblegum pink polyester uniform that clearly identified ...

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment. Medscape recently featured a video interview of Timothy Quill, the palliative-care specialist and long-term assisted suicide activist. He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS). Several points ...

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An excerpt from The Mindful Nurse: Using the Power of Mindfulness and Compassion to Help You Thrive In Your Work. Do you ever feel panic at the end of a long weekend or vacation, wondering where the time went? Do your days, weeks, and months blend into one another, each ...

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In what has been called the “opioid epidemic,” we talk a lot about two groups of people: 1. Patients who try to con their physician to get an opioid prescription, and 2. Physicians who capitalize on these patients by creating “pill-mill” clinics (that dispense opioids generously). This narrative results in top-down regulations that restrict the relationship between physicians and patients everywhere. Doctors are often blamed for the problem, so new guidelines target them. ...

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“Who’s in charge of the case?” the doctor asked a bit impatiently. My husband was in the hospital, and his care seemed disjointed and fragmented. I was concerned and called his primary care physician (PCP) to ask advice. He hadn’t known my husband was in the hospital again and seemed frustrated. I thought about his question for a minute and answered, “I guess I am. I am the one who talks to ...

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