Every patient is the only patient. - Arthur Berarducci Each person in need brings to us a unique set of qualities that require unique responses. - Don Berwick Disease-ify: To generalize and then classify a unique person's health complaint in order to match them with an effective remedy that ends to encounter; often done out of convenience, expedience, or for profit. Unique is a funny word. Every time I come across it, I am reminded of ...

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Here is the setup.  You're working in the ICU.  You want to communicate a prognosis to the family of a patient who is so ill he cannot make decisions.  You sensitively state the facts: the patient has less than a 5% chance of survival.  Or perhaps you say "he will definitely not survive." The family confers, and decides that they want to focus on keeping him alive as long as possible. ...

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Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws ...

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Primary care is ever the Cinderella-esque tragedy. Ever so maligned, ever engulfed in misery and never really the belle of the ball like she rightfully deserves to be. There may be reasons galore to this. Not least of which is the way primary care work is perceived in this country. Let me illustrate. The primary care attending I work with recounted a story from the early 2000s. As is usually the case with visits ...

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One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication. Design a standardized form for all medical reporting. Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with ...

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Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining ...

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“Everything must change, nothing stays the same. Everyone will change, no one stays the same.” Technology is amazing. I love to download random songs on my iPhone and listen to the songs that populate. On one bright early morning, Oleta Adams came on. The song was “Everything must change.” It’s a beautiful and haunting, somewhat sad but at the same time hopeful, song. It stirred up memories, and I found myself ...

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Health reform includes measures to link hospital reimbursement to patient satisfaction measures.  Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future. Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure ...

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I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians.  The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients.  She bemoaned that she was abandoned -- her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My ...

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I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical ...

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