Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment. Writing for the New York Times, Dr. Bob Watcher argues that, "Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, ...

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I’ve been following Marissa Mayer’s tenure for nearly four years at Yahoo.  Not just because I was initially tapped to lead athenahealth’s integration of another mature advertising-driven mobile company -- Epocrates -- but because Yahoo, with its complexity and technology legacies, and highly competitive, fast-paced market environment, reminds me of many of the country’s largest health care delivery systems. Both are facing significant headwinds to stay relevant in their respective industries ...

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The title of Noam Scheiber’s January 9, 2016 New York Times piece on hospitalists, “Doctors Unionize to Resist the Medical Machine,” skirts the bigger issue for doctors, which has less to do with contracts, salaries and labor relations, and much more to do with the question, “Is health care just another business, and if so, can physicians be managed that way?” I’m a silverback hospitalist, and when I started ...

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The American health care system is set up to care for a certain subset of the population -- sick people -- people with chronic disease, acute illness, acute injury, and complex disorders like cancer or metabolic issues. The problem is, this set up doesn’t create market incentives to care for the well effectively, or to identify those at risk for disease and efficiently and reliably intervene, at scale. To reconcile this cognitive dissonance ...

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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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