Encouraging patients to be more engaged, may also encourage more people to go beyond assertive to demanding care unsupported by good clinical judgment. Of course, physicians worry that saying “no” to a patient increases their risk of being disliked, dismissed, or even sued for medical malpractice. Greater transparency in health care means patients are more aware of options for screening, testing, procedures, and medications—often via direct advertising or public service campaigns. ...

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On a recent afternoon, Hansel Tookes stood on a sidewalk in downtown Miami, peering into a thicket of scraggly weeds. "I found a bunch over here," he said, edging toward an overpass. A small orange plastic cap came into sight, and next to it two slender insulin syringes, with the needles exposed. Scattered about were tiny plastic zipper bags -- evidence that the needles had been used to inject heroin ...

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Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether the problem in health care is that patients are too reliant on doctors and don't have the ability to make decisions. In reading between the lines, is that the reason health care is not affordable and care not commoditized or consumer driven like other industries? At a conference for America's Health Insurance Plans, ...

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Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, "Why Women Still Can’t Have It All."  The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two ...

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As odd as this might sound, my mother was upset when I declared my intention to go to medical school. It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade).  It wasn’t the fact that medical school would delay the litter of ...

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"The best defense is a good offense." This folk wisdom is variously attributed to Sun Tzu, Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths. During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors. “So, tell me, I know it’s hard to manage both full time school and a part ...

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In today’s China, both eastern and western medical philosophies and practices exist relatively harmoniously.  Patients with minor, usually self limited problems are treated initially with a seven day course of seven liquid herbal preparations taken each day.  If symptoms subside, usually treatment is discontinued.  If improved but not resolved, formula may be modified.  If worse, regimen can be changed and/or referral to specialists arranged.  There are hospitals that practice purely ...

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I'm always surprised at the number of physicians I work with who worry about, discount, or do not see their relevance outside of clinical practice. I do, of course, recognize their relevance - the trick is to get the docs to. For many physicians, venturing into positions of leadership, becoming a Department Chair, VP Medical Affairs or even Chief Medical Officer) is a logical step for those looking to expand their skills ...

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The last patient of the day rushed to the office before closing time. When I entered the room, the dad was texting as the nurse finished recording the child’s temperature.  He shook his head in disbelief and confessed that he just sent his wife this message, “I feel stupid.  No fever here.” Parents apologize to me everyday because they feel like they wasted my time and/or their co-pay.  Coordinating a doctor’s ...

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Recently I learned that my friend Hester had been suddenly diagnosed with Stage 4 cancer.  She had been focused on daily living, her long road stretching out to the horizon, attending to friends, creativity, work, and related pleasures and struggles.  Within days, her life abruptly made a hairpin turn into a new path, narrow and poorly lit, and short.  One week after I spoke to her, she died. It is at ...

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