How many of the 40 million plus patients undergoing an operation this year are truly informed of their surgeon’s track record?  I suspect the vast majority of patients entering the operating room today are unaware of existing, vital information that would enable them to make an informed judgment on the professional abilities of their surgeon. Most patients who end up in a surgeon’s office are there because their primary care physician ...

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Do you feel like you have nothing to show for the efforts you’ve put into your career change? It’s easy to feel frustrated and lose motivation when nothing seems to be coming from all the work you put into things like LinkedIn, calling recruiters, revising your resume or networking. There are two possible reasons why things might not be working for you.  Maybe you are doing the right things but you ...

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I have a BHAG (Big Hairy Audacious Goal). I want people to hear "family medicine" and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care. I want people to know that family docs take care of a lot of complicated, challenging diseases - and not usually in isolation.  Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, ...

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Here's a devil’s advocate position. Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal.  I don’t mind that. But let’s be truly equal partners then. The patient’s right to choose a doctor and be informed of the best ones via doctor rating ...

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"51-year old female presents today with ..." Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to ...

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I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking ...

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Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators. The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...

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The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved. In Korean culture, questioning authority is unacceptable and led to ...

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When it comes to doctor- nurse interactions, when is enough, enough? Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to ...

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There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem.   To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future ...

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