Let’s face it. A hospital is a place where nobody wants to be. By it’s very nature, it is somewhere scary and not too nice. Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing -- enjoying a leisurely afternoon with the ...

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Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on "medical professionalism" was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:

  1. the principle of primacy of patient welfare
  2. principle of patient autonomy
  3. principle of social justice
The first set of professional responsibilities for physicians was a ...

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Next in a series. Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about ...

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A column entitled "The Questionable Link Between Saturated Fat and Heart Disease" appeared in the Wall Street Journal recently. To spare you any guessing about where this is headed, I'll tell you right away: The column itself was pretty darn questionable. The article starts off very dubiously when the author, Nina Teicholz, tells us that a now somewhat infamous study published in the Annals of Internal Medicine concluded, that "saturated fat ...

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A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network.  After all, the purpose of that network is to link business and professional people to potential opportunities and ideas.  I needed to let contacts know that I am no longer with the university where I practiced for the last seven years, while ...

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Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government. There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. It has all of the features of a talk radio discussion that you might encounter in any US city: Commentators (many of them anonymous) at one extreme or the other of a topic, name-calling, blaming, and empty rhetoric overshadowing the real issues. I am referring to ...

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Last summer I met with a patient in my clinic who had come to the hospital with leg weakness and his CT scans showed widespread cancer. His type of cancer is rare and treatable with a pill, which he had been taking for about a month. He was tolerating it without too much trouble. During our first visit, he was insightful but overwhelmed. “I know how sick I am -- just ...

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Six months ago I saw a 45-year-old former athlete who had three unsuccessful back surgeries, taking 80mg of extended release oxycodone three times a day. He was also inactive and depressed despite counseling. Just five years ago I would have increased the oxycodone to improve his pain and function. Now with opioid overdose deaths, all of us are questioning our practices. As trusted primary care providers, patients ask us if we ...

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The future of our health care system, lies with you, dear medical students and residents. While medical school and residency training does a pretty good job giving you didactic and clinical training, they might do a better job teaching you how to avoid the potential mess you will encounter once you complete your training. Perhaps the most shocking thing I encountered after completing residency training was how non-clinical administrators placed ...

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