If Atlas shrugs off healthcare, it will be a dark day Most modern American are familiar with the classic political novel, Atlas Shrugged.  Love or hate it, the novel had a great impact on political thinking in the West.  If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this:  what if the producers and innovators of society simply stopped trying?  What if they ...

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I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want ...

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I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and ...

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Healthy patients always make the same error Healthy patients think that they are not at risk for serious medical problems. Though maintaining a healthy weight, exercising regularly, not smoking, and eating plenty of vegetables and fruits while limiting meat, fat, and fast foods does decrease the risk of developing diabetes, high blood pressure, heart disease, and cancer, it doesn’t completely eliminate it. The chance is there, just a ...

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The telephone is obsolete: How my patients contact me today “Doctor’s office; please hold.” You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other ways patients ...

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As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared. A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% had ...

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Over at his blog Gene Expression, Razib Khan expressed his disgust with the paternalism of the medical profession. His disgust was not misplaced, but he did bypass some of the subtleties. Razib, a respected science blogger, ran smack into a frightening piece in Time. In it, doctors discuss whether and how much genetic information should be given to parents about their kids. The doctors featured evaluated a ...

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The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system. In the wake of Hurricane Sandy, the visual has become more familiar than we'd like - the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish ...

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I admire the strength and determination of cancer survivorsI was recently sitting on an airplane on my way to a far off destination for a meeting preceded by a couple of days of rest and relaxation. In and of itself, nothing particularly special about that except that maybe a couple of folks will be jealous. But to me, right now it is an incredible moment, the culmination ...

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As physicians, our commitment to the Hippocratic Oath is to first do no harm. That's an ever-growing challenge as patient volume increases and face time with each one decreases. Physicians often find themselves in the difficult situation of effectively communicating important information to their patients in a finite period of time without seeming terse or abrupt. This challenge is further complicated by an evolving framework of reimbursement that is focused on rewarding ...

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