The Wall Street Journal has a question that I cannot really answer in their article, Nurse Practitioners and Primary Care. This question has an implicit assumption that primary care is one thing, and that that thing is relatively straightforward and simple. I have written about this problem incessantly for the past 11 years on this blog. The term primary care has become the equivalent of a Rorshach test. When we ...

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AP8702110449-jpg_230144 I have been thinking a lot about C. Everett Koop lately, ever since his death on February 25 at the ripe old age of 96 and more recently with the announcement that our current Surgeon General, Regina Benjamin, is planning to step down from that post. In particular, I have been pondering what made Koop such an effective Surgeon General, and what ...

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I knew from last night's house call that my patient Bessie's time was near. All day long I'd felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn't surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail. It was Bessie's daughter, Susan. "Mom is gone," she ...

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Hi. I’m Rob and I am a recovering doctor.  Yeah, I am recovering ... doing a lot better, actually.  Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.  I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better.  I ...

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It was just like every other email I had gotten in the past.  A young student at a local university was interested in primary care, and wanted to shadow me for a month between his second and third years.  I responded swiftly.  I was delighted to bolster the interest in my specialty.  Over the years I had helped train students, residents, nurses, and nurse practitioners.  By exposing them to the office, hospital, nursing ...

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The biggest mistake patients make isn’t what you think. It isn’t turning down tests or treatments their doctors recommend. Nor is it deciding not to take the medicines their doctors prescribe. It isn’t insisting on getting a test or beginning a treatment their doctors recommend against, either, and it isn’t failing to exercise, stay out of the sun (or use sunscreen), quit smoking, or lose weight. No, the biggest mistake ...

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I treat uninsured patients and insured folks who face high deductibles who are under financial strain because of the sagging economy and other personal pressures. These folks need care that may be unaffordable. Medical diagnostic testing is expensive. Even routine laboratory testing can be very costly as those without insurance may be forced to pay the ‘retail cost’, which is quite different from insurance company discounted pricing. This absurdity is often ...

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As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can't place medical charts on exam room doors, you can't use sign-in sheets, and you can't leave messages on patients’ voice mail or answering machines. Here, then are ...

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Hospice is beset by many societal obstacles in its care of the transgendered patient.  I saw a most recent example of this in our local community hospice.  An elderly female (MTF) transgendered patient had developed metastatic cancer.  Chemotherapy had failed and had left her profoundly weak and infirmed.  Estranged from her family, she had only a few friends to rely on but then only intermittently so. Hospice admitted her and, with ...

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Decisions in medicine are supposed to rest on concrete observations and hard evidence. Often, hard evidence does not exist or when it does, it isn't used.  Why is this? Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less.  Yet we persist. Why? This is our reality now, our evolving medical world. But if we stop and think about it, medicine, by definition, is a world of technological ...

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