by Steven Knope, MD For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system. Paraphrasing a recent ...

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The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV. His wife was with ...

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Hospital rankings matter. Specifically, those published in the US News & World Report carry additional weight. Hospitals use these numbers in advertising campaigns, and patients often choose hospitals based on these rankings. But does a high place really mean you're getting better care? Not necessarily. The Annals of Internal Medicine took a closer look at the hospital ratings, and found that "reputation score" was a significant factor. Indeed, "the ...

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I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment. I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had a terrific group ...

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by Charles R. D'Agostino, MD We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care. But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked ...

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Donkey Kong has a new record holder. And he's a plastic surgeon. Hank Chien, MD scored 1,061,700 points in 2 hours, 35 minutes, breaking the world-record score for the classic arcade game Donkey Kong. Go and read the piece as to how he did it, and more interestingly, the painstaking steps he had to take to verify his score. The feat does lend some anecdotal support ...

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The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor. Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come ...

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Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month. Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central ...

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Let's face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the "efficient market" described by economists. In such an environment, ...

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The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news. Why is the C-section rate sky high? The pervasive nature of the increase may hold some clues. The increase has ...

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