At the heart of healthcare operations are their processes – processes that must run correctly all the time to avoid unnecessary risk to patients' lives and health. Once the healthcare industry acknowledged the fact that we all make mistakes – even physicians – it began to look into methodologies used by other industries to structure more "perfect" organizations. Two such process improvement methodologies -- LEAN and Six Sigma -- are now being ...

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When I was ten I once found myself walking with my brother on a Lake Michigan beach when we came upon a half-empty bottle of beer. Curious, I picked it up and looked inside at the swirling dark liquid. Then, impulsively, I took a sip. It was hot, having baked in the sun for who knows how many hours or days, and tasted awful. I never took another drink of alcohol ...

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This is my new office.  I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground.  I should feel good about this, shouldn’t I?  I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting.  Yes, there are days I feel good ...

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As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising. That’s also why, at first glance, the federal government seemed to be ...

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Diet and exercise: they were supposed to be the answer to all that ails America's obesity and health care cost problem. Signs of this Utopian vision are everywhere.  From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites that encourage "healthy lifestyles," and entire community efforts to partner with health care organizations to fight obesity with the hope of cutting health care costs. What if, believe it ...

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One cannot escape the issue of rising obesity rates in the United States. A current statistic predicts that by the year 2030, 42% of us will be obese. The ramifications of this ponderous eventuality could indeed weigh down and sink the nation. Some of the consequences include:

  • Zillions of health care dollars spent treating obesity directly.
  • Gazillions of health care dollars treating medical consequences of obesity.
  • Loss of economic productivity from a bloated ...

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She had only been in the hospital twice in her life: once when she was nine and now, 60 years later.  She had gotten tonsils out then.  She was getting tumors out now. Her abdomen hurt when she was awake.  Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia.  Her body would feel it, though, and could respond by dangerously spiking ...

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Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That's what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give ...

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For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management.  It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on ...

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It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour. The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop. “I’ll let the ...

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