Remembering why we got into medicine in the first place can often soften the edges of long, difficult days. My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to ...

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Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come. The word “hospitalist” was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Back then, hospital medicine was a strange new phenomenon. Fast-forward to today, ...

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1. Process vs. product. Computers are just machines.  I repeat, they are just tools.  Health information technology is a shell which houses knowledge and human ability.  It is nothing more .  Electronic medical records may either streamline our thought processes or make them more cluttered.  They will not, however, lead to better or more perfect care.  They haven't yet, and they won't in the future. And they are prone to be ...

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During an afternoon seminar on a new paradigm for lung cancer screening in primary care, my phone chirped announcing the latest MedPage Today bit of breaking news: "Medical Homes May Not Be the Answer." A study in JAMA reported that cost per month per patient had actually increased, and only one marker of improved care was found to have improved after thousands of patients were followed in a large group of patient-centered medical ...

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When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky.  And over time, I came to truly appreciate the small, rural hospitals that called us for help ...

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There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Reagan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother. The narrative of such a woman goes something like this: Not only is she ...

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Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was inappropriate for your patient just to exit the screen? This is the situation with my local medical institution's "DVT Advisor," a mandatory decision support screen for all patients. DVT Advisor was implemented ...

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DSC7649-1024x770 Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice. A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking ...

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I had a pretty grueling office session yesterday -- one of those days where you're sending someone to the hospital and calling another consultant on the phone and bouncing among three rooms at once.  A typical family medicine day. I was 45 minutes late seeing my last patient.  I was a little surprised that she was still on the schedule -- we had actually resolved her issue over the phone the ...

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Next in a series. There is and will be a need for many more primary care physicians (PCPs). Why? There is a shortage now and it will be exacerbated in the coming years for at least three reasons. The population is growing, the population is aging and there will be more individuals with health care coverage as a result of the Affordable Care Act (“Obamacare”). I believe that the need will be much ...

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