It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look. The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered ...

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Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, "Are Children Overmedicated?" seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase prescribing of medication.  In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy to provide ...

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In an article entitled, ”Why the ER admits too many patients,” Dr. Michael Kirsch tries to explain that emergency department admissions are inflated due to emergency physicians acting in their own self-interest.  Many emergency physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs.  I share this visceral reaction in part, but ...

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From the moment some patients arrive in your office, nothing seems to suit them:

  • Your parking lot charges too much.
  • Your front desk staff has too many forms for them to complete.
  • Your waiting room magazines are too old.
  • The temperature in your exam room is too cold.
So why are some patients so grumpy? I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their ...

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It's one thing to ask a doctor to stay current on his knowledge, it's quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research. Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM's requirement for a practice improvement module worth a required 20 ...

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Every time I see a GlideScope, I can’t help but lament, “why didn’t I think of that?”  To me, the GlideScope exemplifies how physicians can apply their practical knowledge of medicine to create technology that improves patient outcomes. I had a front-row seat to physician-designed technology prior to my residency, when I worked at an early-stage venture capital fund advising on health care investments.  We invested in a number of physician-founded ...

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A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, "There's someone you need to see right away." The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she'd been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several ...

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There's no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art? Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in ...

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Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians. The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors ...

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1-Question-Ask-Doctor-1024x839 Your doctor has more control over your life than anyone -- other than you. Your doctor may be the first face you see as you’re born and the last one you see as you die. Doctors look deep inside you, in places nobody has been before. Doctors prescribe drugs that can kill you or save your life. But how do you know if ...

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