Part of a series. Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become ...

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All hopes were abandoned.  In theory, it was supposed to jump start medical care and provide access to the uninsured.  It was the promise of a new day. Every American would have access to good, quality (I really have learned to hate that word), affordable medical care. I’ll never forget that day.  It was raining hard, and my clothes were soaked through. The air felt particularly raw against my skin. The ...

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Supply chains and other service industries, like telecom, worry about "the last mile" -- the final step in delivering a product or service to customers. Like other industries, health care must connect most meaningfully to the patient, and the nurse is almost always part of (if not the sole manager of) that last mile. The analogy of the last mile defines a deeply rooted issue about nursing’s criticality (and that ...

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Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have. Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash ...

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A guest column by the American College of Physicians, exclusive to KevinMD.com. The election year has finally arrived. Even though the candidates have been on the trail for what seems like forever, I wanted to wait until the traditional time to announce the launch of my campaign. Don’t worry, I’m not running for office. My campaign is an initiative to get us to start talking about the “quadruple aim” ...

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The metallic mix of freshly spilled blood and sterile instruments engulfed his nostrils as he shifted uncomfortably in the cracked, worn, brown leather chair where so many others had sat before him. He tried not to sweat as the faceless, gray clinician coaxed the long needle deeper into his fleshy neck and watched as a rogue drop of crimson escaped and marred the otherwise pristine tile floor beneath him. He ...

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All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients. A recent study from researchers in Boston ...

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One of my most memorable experiences was more than a decade ago while working for a level one trauma center on the East Coast. I was sitting in a hospital break room during one of my breaks as an inventory coordinator when a nurse walked in. I simply asked how her day was going, and she fell into the chair next to me crying. Surprised by her reaction, I asked, "What's ...

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An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time. I’ve studied lots of industries. In general, cost and quality compete on equal terms. Some companies emphasize cost, others quality, but both are always in the picture. And then there is health care. Uniquely among industries, health ...

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Consumers spend 16 times as long choosing a computer as they do selecting a health plan for themselves and their family. And it should not be a big surprise. For decades, nearly all insurance companies offered similar choices of in-network physicians and hospitals. And as a result, plans differed only minimally in clinical quality, access and service. And even when clinical outcomes varied, consumers had no easy way to access ...

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