Merrill Markoe's reports that she was fired by her doctor in her article, "My Doctor, the Concierge," which was both sarcastically entertaining and painfully true.  She writes a powerful commentary on the divide caused by insurance companies between doctors and patients.  She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy ...

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"Just start work half an hour earlier." This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles. She suggested that if we started our usual practice morning at 8 o'clock we should just have everybody come in at 7:30 to load the dashboards for the morning session ...

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As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home. We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about ...

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I have just turned on my computer. It is midnight. I should be trying to sleep right now. My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, ...

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Several years ago I took care of an elderly woman in the ER.  She came in with a chief complaint of chest pain.  She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better.  She didn’t know she was about to die, usually people who are about to die look much worse. She looked good, all things considered.  ...

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shutterstock_112344575 Walking parents through the decision to vaccinate their children is a conversation. The vast majority of the time it is an easy conversation. Sometimes it is difficult. If the conversation goes like this, then we, as doctors aren’t doing our jobs: Pediatrician: “Are you going to vaccinate your child?” Parent: “No.” Pediatrician: “Get out of my office.” The medical community has lost a lot of ground ...

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The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be. While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state ...

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asco-logoI gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur -- from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life -- and how important it is to consider the entire journey of a person ...

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A new paper says "metastasis of email at an academic medical center" may cost millions of dollars. A pediatrician from the Penn State College of Medicine kept track of all of his emails for an academic year and found that 2035 mass distribution emails were received. They originated from the medical center in 1501, the department in 450, and the university in 84. The emails were about information technology, academic and professional ...

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Our 13-year-old woke up feeling lousy two days ago. He had a sore throat and sinus pressure, and felt really tired and generally icky. He didn’t look toxic -- just a little tired. I gave him a zinc lozenge and told him to get ready for school -- a method that generally can tease out exactly how bad one of my kids feels. He just sat at the table. We generally ...

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