We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things? Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation. Yet ...

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The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none. Yikes. The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third ...

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Adverse events -- when bad things happen to patients because of what we as medical professionals do -- are a leading cause of suffering and death in the U.S. and globally.  Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical ...

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There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.” I was reminded of that when I read the recent research report and the accompanying editorial in the Annals ...

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Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for WomenInfants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds. One ...

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The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies -- 46% are paying $50 or less. The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose ...

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“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough.  Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada.  Everyone I know believes that  the answer to gun violence is to ban guns,  and if the Supreme Court won’t allow that, to at least license, ...

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I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue. My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans who ...

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If you put ten physicians in a room, you will get nine different opinions.  It doesn't matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of ...

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I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best ...

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