The mission creep of maintenance of certification Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years.  I was in pediatric residency during this maintenance of certification ...

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Why you should love your doctor Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth. Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family. Doctors delay childbearing and starting their own families so they can care for your family. Doctors miss their own kids’ ballet recitals and baseball games ...

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A simple trick to remember your doctors recommendations An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

You’ve told your story. Your doctor gets it. He has completed the physical exam. He formulates a plan to get you better. The next skill you should master may be as important as being a great storyteller. Your doctor has told you the ...

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I am not strongly against the death penalty on principle or on moral grounds -- assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals. I don't even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a ...

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Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.” Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream. Can I see a show of hands, please? That part of us, the one that strives ...

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Replacing transcriptionists with physicians is a fools bargain My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions. The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If ...

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It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; ...

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How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between? I frequently speak with large audiences, ranging from CEOs to Stanford business school students. I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do ...

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The world is asunder.  Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping ...

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FiveThirtyEight had a provocative article: "Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much." The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have ...

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