The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it. Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, ...

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Dissent and cynicism: Learning from listening to doctorsDissent and cynicism: Learning from listening to doctors An excerpt from The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care I just listened. They were very unhappy and angry. I was elected executive medical director in November 1998 but would not assume the leadership role until January 2000. This was fortunate. I knew that ...

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What every college freshmen ought to know about sexual assault Dear college freshman, I just saw you in clinic a few weeks ago; your last check up before college. We talked about a lot of stuff, updated shots, filled out forms, hugged good-bye; crammed in what we could in just a few minutes. It was a great to see you. Now that you are out of the office, away from the distractions of a buzzing ...

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MedPage Today recently tackled a very controversial issue in medical practice.  The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures.  As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice. According to the 
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Top stories in health and medicine, September 1, 2014From MedPage Today:

  1. ZMapp Ebola Drug Effective in Macaques. A controversial cocktail of Ebola antibodies was safe and highly effective in saving the lives of rhesus macaques, even as the animals neared death from the virus.
  2. Depression in Cancer Common But Untreated. The vast majority of clinically depressed cancer patients receive no ...

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My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

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Part of a series. Over the past few months KevinMD.com has posted a series of articles by me on what I call the “crisis in primary care.”  Most recently have been a few posts related to direct primary care. They have generated many comments: some pro and some con. I have greatly appreciated everyone’s interest; it makes it worth the time to write. I am also working on a book on ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it's every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will ...

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Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly ...

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