Once upon a time people only went to the doctor when they felt sick. For most of human existence there was not much the doctor could actually do when you got there. Yet somehow the human race managed to get through to the second half of the twentieth century when things changed completely. As technology advanced exponentially we developed a range of treatments so that conditions, which used to be fatal ...

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Physician Quality Reporting (PQRI) sounds good, doesn’t it?  After all, delivering “quality” is what it’s all about, right?  Maybe.  Maybe the government’s efforts are really designed to improve the quality of the practice of medicine in the US.  Unfortunately, PQRI has fallen short of its reported goal by a long shot. PQRI is time consuming.  PQRI is expensive.  I think PQRI has more potential to do harm than it does to ...

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Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a ...

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As I write this post a frail sickly patient awaits anxiously by the phone for a call from her doctor that will never come.  Every day, countless people leave their physicians office angry, confused, and feeling abandoned.  Yet when I think back to my medical school class, I feel nothing but pride.  I couldn't imagine a more caring, conscientious group of young learners. I remember my fellow residents working long hours.  They abandoned their families ...

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Today would have been easier if I did not give a damn.  Easier if patients were clients.  Easier if medical advice was causal suggestion.  Easier if I believed that patients were solely responsible for their health.  Easier if suffering was not real.  Much easier, if I did not care. However, despite the popular movement from “the doctor knows best” towards shared decision-making, I feel responsible for my patients.  What happens to ...

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All of us hate waiting in lines.  Our society breeds a “me-first” attitude.  Often the lines in which we wait are slow to move and, we become irritable and angry.  Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because ...

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In a new study published in JAMA, my colleagues and I found that even after accounting for productivity, women working as physician researchers at American Medical Schools are paid $13,000 less per year than their male colleagues, a difference that amounts to hundreds of thousands of dollars over the course of their careers. But does this difference stand as evidence of discrimination? Many claims of gender inequity in pay have suffered ...

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When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.”  Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions.  What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, ...

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June in the United States heralds the month when residencies end and new ones begin.  While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations.  I had the pleasure of doing so recently. Excitement. With all of the dreary news of ...

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I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country. The problem is that it’s too expensive and often isn’t very good, but that’s clear. The reason medical care in this country is fragmented  and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly ...

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