If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata.  You may find those colleagues revolting; I know I did.  I despised these physicians and felt nauseated even to be in the same room as them.  But as time went on, I realized that almost nobody starts a career ...

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21 minutes on the phone for a pre-authorization? Watch Dr. Ryan Neuhofel try to get a CT scan "approved." Take a deep breath, and press play. Want to escape pre-auth hell? Consider attending the Direct Primary Care Summit.

Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one. Unfortunately, many of the tactics used by administrators have done little to achieve that goal. ...

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Bacteria are rapidly becoming resistant in our antibiotic-loving society. This statement is a fact. We are facing a threat not only to our country, but to the world. I have a proposal to make: over-the-counter antibiotics. (Insert tongue-in-cheek here.) Will this help us deal with the falsely popular notion that antibiotics are a cure-all? I don’t know, but here’s something I do. I've had patients storm out because I've said no, and I ...

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Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty. “Once you ...

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Imagine two babies being born at the exact same time: a little girl in Sweden and a baby boy in Mozambique. What are their chances for a long, healthy life? In the Scandinavian country of the easily assemblable IKEA furniture and the most secure car in the world, life expectancy in 2015 reached 81.98 years, while in the South African Mozambique with 11.64 billion dollar in public ...

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Be involved, and ask to see your pathology report.  Once you do that, the College of American Pathologists shows you how to read it.

“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public.  As a PALS instructor for more than a decade, I have always responded when possible.  In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies.  A week ago, I discovered the best reason I ...

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In his last state of the union address, President Obama reinvigorated the nation’s interest in a long-sidelined disease/s: cancer. A call for a moonshot was announced, and the president in his address said, “I’m putting Joe in charge of mission control.” The last time such a national commitment towards this illness was announced was by the efforts of a cancer advocate, Mary Lasker. She advocated fiercely, and the National Cancer Act ...

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As a researcher, there may come a time when you interact with the media. It may make you cringe; for traditional research publications, we have the protection of editing, and feedback from mentors and colleagues. Interviews feel much more risky: Questions are unpredictable, and there is seldom an opportunity to polish the product before it goes into the wild. Yet, interacting with the media offers an opportunity to garner attention ...

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Transparency -- or its absence -- continues to fascinate health care analysts and health care economists.  A study published in the Annals of Internal Medicine addresses the effects of public reporting of hospital mortality rates on outcomes.  Its senior author, Dr. Ashish Jha, offered his perspective on the study results and on the topic. According to the study investigators, mandatory public reporting of hospital mortality is not improving outcomes.  The result of their analysis surprised them ...

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Last week, when I stubbed my toe on our family room coffee table, a throbbing pain ensued. Over the next two to three days, as the bruise turned pink and then purple, the pain persisted. During the same time, I had a case of the blues. I am overstressed at work with several staff on vacation, my college-age children had come home and then left to start their internships, and my ...

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As a member of the general population, we see physicians as those who were born with a calling. Though society acknowledges that becoming a doctor is difficult, it is near impossible to fathom exactly what that title entails. I was raised in a small rural community in which resources were quite limited. The nearest grocery store was a 35-minute drive away, there were no coffee shops or traffic lights, and we ...

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I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose -- a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure ...

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Get a group of health policy experts together and you’ll find one area of near universal agreement: We need more transparency in health care. The notion behind transparency is straightforward; greater availability of data on provider performance helps consumers make better choices and motivates providers to improve. And there is some evidence to suggest it works.  In New York State, after cardiac surgery reporting went into effect, some ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg ...

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Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person diseased: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false negatives and false positives. To ...

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The USA trains its physicians differently from every other Western country I know. Everyone (with rare exceptions) who goes to medical school first must get a four-year undergraduate college degree in something. There are no such degrees in medicine, although the overwhelming majority of students going on to medical school major in one of the sciences, such as chemistry, biochemistry, and biology. If they don’t major in a science, they generally ...

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One of the topics’s that I’ve written most about, and also do a considerable amount of non-clinical consulting work on, is how we can improve health care information technology and electronic medical records. As they currently exist, there are unfortunately many drawbacks to health care IT systems, and they have as yet failed to fulfill their immense promise. I’m not a technophobe by any stretch of the imagination. I embrace technologies and ...

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When my father died three years ago,  my comments at his funeral noted that the greatest aspiration any of us can have is to make a difference in the world.  My father’s life made a difference. I’m always self-critical and analyzing my own life.  I moved to Boston 20 years ago this month.   In those 20 years of service to Beth Israel Deaconess Medical Center (BIDMC), Harvard, numerous federal organizations, ...

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