I am on my last rotation for medical school. It is a “rural selective”, which is a required elective at a rural or underserved location. I am fulfilling it at a local community health center in the women’s health department. Fun! I am taking part in a day long orientation today. In one of the presentations, the speaker had a point on one of the slides about mandatory reporting, and included ...

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Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the ...

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The United States of America is an immigrant country. It is a melting pot of many peoples and has basically been so since before the Mayflower passengers laid foot on New England soil. Promise of equality, success, quality of life and freedom have drawn multitudes of professionals from all over the world to try to make it in the US.  Some of these professionals are doctors. A doctor that wants to ...

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How can you determine whether you are in a "developed" or a "developing" country? We used to call these latter "un- or underdeveloped" or "3rd world" countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic. If one objectively examines all 20 dozen or so of the world's countries, a geographer would divide them into either north or south of the Equator. And if, ...

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Hospitals commonly espouse a commitment to patient-centered care (PCC). Most fail to achieve it. Causative factors are legion. PCC is often considered a strategy or a tactic, for example, when it really should be integral to an organization’s culture, and enabled by a supportive vision. Some organizations appreciate this, yet still struggle. This is understandable. Today’s health care providers were not trained to provide PCC. They lack the requisite skills, ...

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For various reasons our nation’s public health programs have been decimated. This comes at a time when the number of unemployed and health uninsured are at a record high number. Additionally, we are seeing individuals live longer and experience more chronic debilitating illnesses and conditions that stretch the resources of an already under manned and under funded health system.  Emphasizing prevention and healthy living should be a lifetime necessity for ...

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Sometimes a patient interaction leaves you speechless. In my experience, that most often occurs when a patient refuses to acknowledge any responsibility for their condition despite massive evidence to the contrary. This is compounded when dealing with caregivers of patients who don’t just drop the ball, they kick it into the next county on purpose. Here is an actual phone conversation between a fellow physician and a son of her two ...

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Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.  Many articles, both pro and con, have been written regarding P4P.  I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.  I also believe that ...

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In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter. In the literature I found jagged graphs plunging downward, indicating that my ...

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As I enter the hospital in which I work, I am struck by a number of signs that denote that my place of employment is a Christian hospital, with Christian values, and a Christian "vision" of health care. I don’t have the vaguest clue as to what that means. And I don’t really  mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem ...

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