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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One of the big practice challenges most physicians face is a frustrating gap in our leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients. This new leadership role can be daunting. We are prepared to diagnose and treat, but what about all the other questions that come our way?  At times It ...

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For years, I have been telling families in my practice, especially those with teens, to eat dinner together. Family dinners make a difference, I tell them. Studies show that they not only help prevent obesity, they help kids do better in school and help keep them out of trouble. Now a study says that’s a bunch of hogwash. Well, not exactly hogwash. The researchers from Cornell who wrote “Assessing Causality and ...

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Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus. Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by ...

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The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet: "The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about ...

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Does your doctor have something on the wall that starts with “American Board of ... "? The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown on what’s at stake in the distinctions. The first thing to understand is that anybody who has ...

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Recently our department of medicine grand rounds was on the subject of asthma.  It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades.  The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part. As someone who works in an academic hospital, I know many physician-scientists.  ...

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What do you think is the physician-view of an "ideal patient"? Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can't believe that we will be so lucky. ...

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Does it really make sense for a neurosurgeon to be quoted in a news story about a new treatment for diabetes or prevention of obesity? Some news reporters think so, leaving primary care physicians frustrated at the media’s lack of understanding about the wide range of expertise they practice on a daily basis. In both news and entertainment media, seeking out and representing primary care expertise seems to be the ...

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