As I write this post a frail sickly patient awaits anxiously by the phone for a call from her doctor that will never come.  Every day, countless people leave their physicians office angry, confused, and feeling abandoned.  Yet when I think back to my medical school class, I feel nothing but pride.  I couldn't imagine a more caring, conscientious group of young learners. I remember my fellow residents working long hours.  They abandoned their families ...

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Today would have been easier if I did not give a damn.  Easier if patients were clients.  Easier if medical advice was causal suggestion.  Easier if I believed that patients were solely responsible for their health.  Easier if suffering was not real.  Much easier, if I did not care. However, despite the popular movement from “the doctor knows best” towards shared decision-making, I feel responsible for my patients.  What happens to ...

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All of us hate waiting in lines.  Our society breeds a “me-first” attitude.  Often the lines in which we wait are slow to move and, we become irritable and angry.  Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because ...

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In a new study published in JAMA, my colleagues and I found that even after accounting for productivity, women working as physician researchers at American Medical Schools are paid $13,000 less per year than their male colleagues, a difference that amounts to hundreds of thousands of dollars over the course of their careers. But does this difference stand as evidence of discrimination? Many claims of gender inequity in pay have suffered ...

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When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.”  Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions.  What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, ...

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June in the United States heralds the month when residencies end and new ones begin.  While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations.  I had the pleasure of doing so recently. Excitement. With all of the dreary news of ...

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I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country. The problem is that it’s too expensive and often isn’t very good, but that’s clear. The reason medical care in this country is fragmented  and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly ...

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One of the big practice challenges most physicians face is a frustrating gap in our leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients. This new leadership role can be daunting. We are prepared to diagnose and treat, but what about all the other questions that come our way?  At times It ...

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For years, I have been telling families in my practice, especially those with teens, to eat dinner together. Family dinners make a difference, I tell them. Studies show that they not only help prevent obesity, they help kids do better in school and help keep them out of trouble. Now a study says that’s a bunch of hogwash. Well, not exactly hogwash. The researchers from Cornell who wrote “Assessing Causality and ...

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Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus. Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by ...

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