My in-laws are in town for my daughter’s graduation.  When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law.  ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor.  The one you found for us is wonderful.” My wife smiled at me warmly.  I just earned myself big points.  Yay! Her parents and mine are ...

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I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, "I think she's doing better, ...

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I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because all his monitors and machines seem to be bleeping and bopping and malfunctioning at once. I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other ...

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It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to  negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer. If you have been ...

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We talk of disruptive change in health care as a tectonic cataclysm.  We're hanging by the moment for that one innovation that will flip flop the practice of medicine and bring better, more efficient care.  But if you ask the poor lowly physician struggling on the front lines, we might tell you something different.  We are suffering through a sustained, insidious, devolution.  I see great change. Reform takes place in fits ...

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"Oh, by the way" are four simple words that cause most docs to shudder.  Yes, shudder.  Your patient signed in for a sore throat, congestion, and cough.  The nurse did her job.  She’s recorded the patient’s chief complaints.  She’s taken the patient’s vital signs and readied the patient to see me, the doc. I take a history, asking questions about the problems that brought the patient to the office.  I ask pertinent ...

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Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients. Recently I put together a talk about recommendations for ...

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Some things in medicine are obvious.  Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right.  I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of  dollars and heroic clinical effort to our continued goal of staving off death.  Why is this?  Do ...

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In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed ...

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Patients often don’t get the respect they deserve. Take the subject of patient engagement.  Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health. But is that really their role? Patient engagement is not the job of health care providers Why?  Because by the time a person (aka patient) ...

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