The world of health care has made tremendous progress in the last several years in raising the quality and safety of clinical medicine. Despite this, the discharge process (when patients are discharged from hospital) is still fraught with potential pitfalls and opportunities for things to "slip through the net." If you ask most patients who are discharged -- particularly the elderly with multiple medical problems -- they will tell you that ...

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In the academic world, there is an unspoken rule under which faculty, residents, and fellows collectively live and work. Educational programs are to be separate from industry and its financial stronghold. I understand the rule and its application in certain scenarios and clinical departments. But I would like to challenge it within my specialty of orthopedic surgery. As I finish up residency and look ahead to fellowship, I am constantly thinking about ...

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It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g., gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists)  Even ophthalmologists have subspecialized into groups based on the part of the eye that they ...

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There’s a lot of talk these days about patient satisfaction. Physicians are being measured in so many different ways. What concerns me is there’s not much talk about physician happiness. With levels of physician burnout and discontent growing, why not pull back the curtain on how to improve physician happiness? Let’s think back to what life was like in grade school. For those of you who have children, what is the ...

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January marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing. Not a who-done-it, but a why-done-it. If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will ...

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Like most doctors, I was a young resident, fresh out of medical school, when I had my first experience with the American way of mistreating the dying. Taras Skripchenko was a frail, bed-bound 78-year-old man with inoperable lung cancer who was admitted to my service during my first year of residency training. Skripchenko was too confused to have a lucid conversation and lacked family members to guide his decision-making. His oncologists hadn’t ...

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The insurance companies have discovered a new way to give me a headache. About a month ago, a number of providers in our practice received an email with instructions about a new task to which we had been assigned. Apparently, we were supposed to log on to some website, create an account, and fill out a SOAP note on about a dozen of our patients. Wait, a SOAP note? Didn't I write one ...

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Health care in the United States is often compromised by fragmentation in its delivery, limited patient access due to a shortage of primary care doctors, long wait times (even for patients who have appointments), and spiraling costs. As a result, innovative approaches to delivering health care are becoming increasingly important in America’s continued pursuit of improved outcomes and reduced cost of care. Health care delivery models such as telemedicine aim to ...

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Dr. Oz is going to love this one. At least, I think that he will. I've never actually met him. To be honest, I wouldn't have a clue as to whether he's really a good guy or not. In fact, I suspect that he's never read my book, but I did devote almost an entire chapter to him, because he intrigues me by being a physician businessman. All I can tell you ...

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Our health care system needs more physician leaders. Physician-led accountable care organizations have been shown to improve the quality of patient care while reducing overall costs. Physicians, by their nature, tend to be goal-oriented, have the ability to gather and assimilate evidence, and make difficult decisions, but these traits do not always translate naturally into leadership skills. We are trained to make a diagnosis and map out a treatment plan ...

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