Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated resources -- too much testing and treatment for people who don't need it and lousy access for many who do. The impact of advances in medical science on the delivery of ...

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Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees. Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These gripes are ...

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By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. ...

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Our culture -- at least the movie-going part of it -- seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered. After ...

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Where do I start with this: The $2.7 Trillion Medical Bill. I’m going to let Ms. Rosenthal tell you about how many unnecessary colonoscopies we do.  I’ll let her tell you how much more it costs here than anywhere else.  I will address the anesthesia bit. Let me tell you a little story.  When I was a baby anesthesiologist my hospital sent anesthesiologists downstairs to do anesthesia for GI procedures ...

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A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor ...

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A moving van pulled up to my house the other day. It contained the last of my mother’s belongings, a few pieces of furniture that neither my brothers nor I nor our children had wanted. It’s been over four years since Mom died and we finally gave up trying to sell the things down in Florida, where they’d been sitting in storage. Among the items was a china cabinet fashioned from ...

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Mandela_2_0 If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that trajectory when he was rushed to hospital in the middle of the night more than two weeks ago. It would not have ...

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shutterstock_136905509 In 2006, as I was starting my geriatrics fellowship, we started renovating our home. This took almost two years from start to finish. It was a long, arduous, expensive, and often stressful process. And this experience ended up profoundly influencing my philosophy as a primary care physician, and my approach to practicing medicine. To this day, I’ve had minimal experiences as a primary care ...

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As a practicing primary care doctor, I very much believe that better care is when patients are engaged and share decision making with their doctor. Though in the past doctors treated patients in a paternalistic manner, my generation of doctors has been taught to uphold a balanced doctor-patient relationship and partnership. This change in balance of power has accelerated with the ease and availability of information via the internet. More ...

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