As a practicing primary care doctor, I very much believe that better care is when patients are engaged and share decision making with their doctor. Though in the past doctors treated patients in a paternalistic manner, my generation of doctors has been taught to uphold a balanced doctor-patient relationship and partnership. This change in balance of power has accelerated with the ease and availability of information via the internet. More ...

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Family physicians told us they are more comfortable with uncertainty than the "ologists." For a little history, the Future of Family Medicine project published in 2004 identified this mental attribute as an important defining skill of family physicians. This ability manifests itself across the entire spectrum of family medicine. An example is reassuring a young mother that her infant with a fever will probably be fine – and ordering no ...

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“You don’t have any idea what you’re dealing with, do you?” asked Mr. Johnson a mere two minutes into my interview. The scene is the Crisis Intervention Unit. The time is 3:00am. I have a feeling my breath is terrible. The hospital pizza I engulfed earlier in the evening has decided to stage a churning acidic protest in my guts. However, far worse than my half-closed eyes, my halitosis or my ...

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Walgreens, the country’s largest drugstore chain, announced that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The nurse practitioners (NPs) and physician assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose ...

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The AMA recently announced that they now considered obesity to be a disease.  This announcement set off the usual firestorm: swarms of posts and comments on the internet and elsewhere by highly opinionated people, each of whom was certain of his or her position. There were those who were predictably outraged ("obesity is solely the result of gluttony and lack of will power!") and those who welcomed the new label as ...

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It feels dangerous to write this, but ... my practice seems to be working. But as afraid as I am to admit it, the thing that was once just a good idea is now actually growing and improving.  We are up to about 300 patients (with a big infusion when a local TV network did a story on my practice) and have enough money to pay bills without a visit from ...

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Nothing exemplifies more the complete lack of understanding of the issues surrounding our healthcare system than an article that appeared in the New York Times recently. Author Jane Brody’s piece attempts to address issues with the astronomical costs and misuses of emergency department (ED) visits in the US today.  While I agree that ED visits for routine issues are a waste of resources and money, her suggestion that physicians should ...

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It's not exactly Dr. Jekyll and Mr. Hyde, but everybody knows my level of patience varies from time to time.  So I was surprised to find myself happily telling the emergency room that I would assess the patient shortly.  The kids were horsing around on the playground, and I knew I would have to call my wife and ask her to come home.  It would be my second 45 minute trip to the hospital on ...

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Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree. Right. What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking ...

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Do you report it to your supervisors?  Go to the police?  Go to a rape crisis center?  Or would you try to carry on the next day because you are the only one who has certain duties that need to be done? Or do you keep quiet because you are afraid of the negative publicity and treatment that might befall you, your department, and your medical center? This is not an ...

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