Why you need to hear from miserable doctors Is being a physician a good gig, or not? In a piece that's gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving ...

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A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog. To remedy our fragmented health system, reformers want to consolidate health care.  President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform.  To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices.  Today, about 39% ...

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Let's talk internal medicine maintenance of certification (MOC). I recertified back in 2011, and it was an onerous process capped off with a challenging exam.  Thankfully I passed, and I'm good until 2022. Since then, the American Board of Internal Medicine has made maintenance of certification a more "continuous" process, and is sparking some outcry among physicians.  Wes Fisher has multiple posts on his site ...

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A version of column was published in USA Today on January 19, 2014. Over half of physicians today use electronic medical records, thanks to the federal government spending more than $22 billion dollars incentivizing providers to transition away from paper charts.  Supporters of digital records, including President Obama, say they improve patient care and reduce health costs.  Having navigated a transition from paper charts to electronic records in my own practice, ...

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Mammograms: Breast cancer screening as an individual patient decision In a major cancer screening development, a study from the British Medical Journal found that an annual screening mammography didn't result in a mortality benefit:

Women screened annually by mammography for 5 years had had a breast cancer mortality hazard of 1.05 compared with the control group during the screening period. During follow-up for a mean of 22 years, the mammography group ...

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A version of this column was published on January 26, 2014 in the New York Times’ Room for Debate blog. The president should invite someone crucial to the success of the Affordable Care Act: a practicing primary care physician. Obamacare admirably expands the opportunity to purchase affordable health insurance to the previously uninsured tens of millions, either by expanding Medicaid or through health exchanges like HealthCare.gov.  Yet without a strong primary care backbone, those ...

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A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department. The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It's essentially a naturally-occurring randomized controlled trial. The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy ...

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A version of column was published in USA Today on November 20, 2013. I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin.   When I saw him months later for follow-up, he admitted that he didn’t fill the prescription. “I took red yeast rice capsules instead,” he said. When I asked him why, he told me that he was wary of statins’ long list of side effects ...

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New cholesterol guidelines: The statin decision lies with patients The release of the new cholesterol guidelines from the ACC/AHA is big news.  It represents a fundamental shift in how we prescribe statin drugs. As with many sweeping changes, there are some good, and some controversial ideas. I like removing non-statin cholesterol drugs from the recommendations, such as Zetia.  Many haven't been shown to save lives or decrease cardiovascular events. Also, removing LDL targets can simplify ...

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Google Helpouts will bring telehealth to the masses Google Answers was a service that was launched in 2002 where users would pay money to ask questions, and a Google-vetted researcher answer them. As many who have seen me speak know, I was a Google Answers researcher, where I answered health-related questions. Google Answers closed in 2006, but recently, version 2.0 of Google Answers was announced: Google Helpouts. This ...

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