This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, "Culture eats strategy for breakfast." Look at ward attending physicians.  The same attendings have “good teams” every ...

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(Because sometimes my brain processes information in the form of a radiology report.) EXAMINATION: Analysis of physician burnout CLINICAL INDICATION: Increasing use of term physician burnout, particularly via social media, and need to address associated connotations/perceptions TECHNIQUE: Non-scientific retrospective review of popular published pieces on the topic and comments platforms on these articles COMPARISON: Innumerable articles on the topic and experiences of professional and personal contacts FINDINGS: The number of articles about physician burnout have ...

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With the upcoming presidential nominations on the horizon, one of the go-to topics for candidates has been health care. What’s wrong with it. How we can fix it. Is it Obama’s fault? But there is actually one key piece of the puzzle missing which actually can create a win-win situation. It’s a very simple strategy: Pay doctors more. When the idea of paying doctors more money for their work is proposed, ...

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In February 2015, the British Parliament approved the creation of a human embryo from the DNA of three people: mother, father and a donor mother. The modified in-vitro fertilization (IVF) technique, called mitochondrial replacement therapy (MRT), would help some mothers with known rare mitochondrial mutations avoid passing on unhealthy defects. These defects can cause severe or deadly diseases, which are often incurable, such as muscular dystrophy, heart and kidney disease, liver ...

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For a moment, let's forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not. I would rather, however, look at how Donald Trump in the White House might affect the day-to-day lives of physicians. And by this I am not referring to his support or opposition to universal health care, for I ...

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Part of a series. Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike. First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction ...

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5 a.m. on a Friday morning, during a lull in my overnight shift, I got a text from my friend Julie (name changed). “Steve had a massive heart attack.” Me back: “OMG, what happened.” Julie: “Not sure, he called my mom, he thought he was going to die. Now they are doing a CT scan.” And so it went on. As I waded through the information, Julie thought she understood I realized that she ...

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Three (and a half) years ago, when I left my old practice, I was near burnout.  I was exhausted, not because of the amount of time I was spending -- it was actually about the same, if not less than I had worked before -- but because of an ever-increasing gulf between me and my patients.  I have always tried to give care that focused on the person with me ...

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Science, to use the term correctly, isn’t a body of knowledge or a bunch of facts written up on a whiteboard by a crazy-haired professor. It’s a method, or way of figuring out things. Thinking and reading and learning from experts are all important, sure. But real science relies on experimentation. First, make an educated guess about how something works. Then design an experiment to test your guess. (I’m oversimplifying here. ...

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Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators -- to varying degrees. It almost seems like a rite of passage that the world of clinical medicine and administration are ...

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