Inscribed on a plaque just below a statue of an eagle in front of my hospital is a famous quote from President Abraham Lincoln that begins, “To care for him who shall have borne the battle ...” It is the reason why the Veterans Affairs (VA) system exists. It is the reason why we VA physicians come to work each day. I am honored to care for our special patient population, ...

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It has been known for a long time that “health care” -- all the stuff that we do, prescribe and provide -- is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care. I ...

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shutterstock_151206914 A few weeks ago I wrote a piece about performance metrics in medicine.  People asked me:  “Well, if you don’t like the metrics, what would you use?”  So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education. Standardized testing has become ubiquitous in schools.  ...

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I just finished reading the Journal of Hospital Medicine article called “The highest utilizers of care: individualized care plans to coordinate care, improve health care service utilization, and reduce costs at an academic tertiary care center.” Using a multidisciplinary team of volunteers including members from hospital medicine, ER, psychiatry, ambulatory care, social work, nursing and risk management,  individualized care plans were developed for high utilizer patients.  These patients had multiple ...

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When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics ...

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This is important to you. Trust me. If you’re young at heart, it matters because it’s your tax dollars this April. If you’re wiser in years, it directly affects your health and the system you’ve been pumping money into for decades. This is the same medical system that you thought would take care of you later in life. Again, this is about your money and your health, so read on. Government-funded health insurance in the United States is administered ...

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According to OECD data, Americans see doctors less frequently than people in any developed nation. We are hospitalized less frequently, and we stay in the hospital less time than citizens of other nations. The vast majority of Americans, more than any other nation, describe themselves as healthy, and America has the largest percentage of young people in its population. So why is health care in America so much more expensive ...

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I am not an economist. This is how I start my high-value care session during the internal medicine clerkship orientation day at the Medical College of Wisconsin (MCW), and it is absolutely true.  It doesn’t take an economist, though, to realize that health care is too expensive.  Health care spending as a percentage of GDP has increased from around 7 percent in 1970 to almost 18 percent in 2010.   An ...

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Life is tough for physicians in solo and small group practice.  The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases.  “Meaningful use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive.  And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data ...

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Health care in America is a perfect example of the Pareto principle, because 80 percent of our gargantuan expenditures on health care are due to only 20 percent of us who are very sick, elderly, disabled and vulnerable in many other ways. If we genuinely wished to reduce health care expenditures, common sense dictates that we would leave the 80 percent alone and zero in on those 20 percent, trying to ...

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