Dr. Atul Gawande has written a much-ballyhooed essay in the New Yorker, entitled "Big Med." His piece proposes The Cheesecake Factory as a model for healthcare. For me, a physician, Dr. Gawande's message left a bad taste in my mouth. The Cheesecake Factory succeeds because of standardization and efficiencies, with complete control over purchasing and production. What recipes work become menu items throughout the chain. What recipes don't work are ...

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The most common complaint about physicians on the Internet is, “They didn’t listen to me.” You were sitting in the office and the doctor was physically present in the room, but they weren’t all there. Even worse is when the doctor doesn’t try to understand what you are going through. Sometimes it can seem like they didn’t even care. Most of us take for granted that we are the center of the ...

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All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies. Why? Because they are the only games in town, and both security and safety are top Maslow imperatives. The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a ...

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Years. Years of learning that the smallest details of a patient’s life can be the most compelling and important part of their story. Years of listening to to tales of love, anger, and loss until the patterns become less daunting and more obvious. Years of hearing things that are so bizarre, so far-fetched, so on the fringe of humanity that nothing surprises anymore, but everything still fascinates unceasingly. Years of trying every new thing ...

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On September 10, 1986, soon after I completed my residency in internal medicine, I “took the Boards” – the certifying examination administered by the American Board of Internal Medicine (ABIM). A few months later, I learned that I passed the exam, and that success, combined with an attestation by my residency program director, rendered me “board certified.” I was granted lifetime certification – my framed certificate implied that ...

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Recently, a former clinic patient was admitted to the hospital.  This man and his family had been struggling with his cancers for several years.  His first cancer had led to a total voice box removal with tracheal stoma placement years ago, which prevented him from talking.  His post-operative condition made communication even harder for this non-English speaker, who then depended upon an English-speaking family member to translate. Then, two years ago, ...

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In "Big Med," his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing that the Cheescake Factory and other upscale restaurant chains successfully lower costs and improve quality by "studying what the best people are doing, ...

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I just finished the just profoundly awesome article "Why Women Still Can't Have It All" by Anne-Marie Slaughter, in this the Atlantic. This is the article that has all the buzz going about professional women and work/life balance. It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what ...

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The unspoken sentiment towards patients with advanced cancerI have been thinking about the cancer experience—what it must be like to be on the receiving end of a cancer diagnosis, to live with cancer, and to experience the treatments; to receive the news that treatment worked or that it didn’t. I also have been thinking about what it must be like to “carry” a diagnosis of cancer around. ...

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In order to be with my Dad, after dinner I'd go on house calls with him.  We'd drive to parts of town I'd never seen, and using the car's spotlight we'd search out the right house number, often with no small difficulty.  I'd usually wait in the car.  He hefted up his rather large mysterious black doctor's bag and headed for the door.  He spent about a half hour listening ...

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