From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events: "Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the ...

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I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, "But I must say, it’s a sincere fortune to be a doctor some days. Yesterday ...

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Recently I was asked, “How can I improve my Press Ganey scores?”  Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals.  Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS ...

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“You are too smart to do primary care.” I have heard this far too many times, directed at me and at others seeking career advice.  There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this.  Smart, capable, successful trainees are discouraged from choosing primary care.  It is perceived as a less prestigious pathway than specializing. The knowledge base of primary ...

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On my way to the hospital last week, I heard a 26-year-old woman describe her experience of becoming deathly ill. When she first realized that the many bruises appearing spontaneously across her body were unusual, she was working as coffee shop to pay off school loans. With the urging of a friend, she went to see a physician. The diagnosis was acute leukemia. Her job did not provide health insurance and ...

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Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated?  Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal. Professor ...

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All of us would like, whenever possible, to have a bilateral referral arrangement with our colleagues. Have you ever experienced a situation in which you are sending patients to another physician and receiving no reverse referrals? Of course, you can change your referral source, hoping that the other physician will notice that there is a decrease in referrals and will call you to ask what happened, but do not hold ...

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A recent New York Times article predicted that accountable care organizations (ACOs) and similar care consortiums will completely upend health care delivery in the United States by 2020. While that’s provocative speculation, physicians and other care providers practicing in population management entities do need to ramp up their ability to explain new health care delivery models to their patients. In doing so, they will want to pay particular attention to increased expectation ...

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The Hollywood treatment of oncologistsRecently, I passed my friend and colleague, Dr. Ekaterini Tsiapali, in the stairwell. We rarely get to catch up these days, so it was really quite a nice surprise to see her. "What did you do this weekend?" I asked. "I watched Wit, you know, the movie where Emma Thompson plays Dr. Vivian Bearing, a 50-year-old woman with terminal ovarian cancer? She's such ...

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I walked down the hospital corridor listlessly. My feet dragged as they fought each attempt to lift off the ground. My body was tired and achy. The phone calls the night before had been relentless. Each stolen moment of sleep was interrupted before a deep, restful state was reached. It was Monday morning. I sat at the nursing station flipping through charts. A colleague across the table was staring intently at ...

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