I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid. Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: ...

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We hear that doctors do not like "protocol medicine" – they do not want to follow a "cookbook" when every patient is different. It is not a good understanding of the issues. Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to ...

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When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care. There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem ...

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So, here we are, between a Medicare rock and budget hard place. Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per capita costs, in 2003, in the US were $3,394 above those of the UK. Doctors face difficult choices to save Medicare We need to work on the costs. That’s clear. But ...

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There are two camps in America: those who think that health care is a right and those who think that it's a privilege. Well, perhaps that's a bit of an oversimplification, but bear with me. Given these two respective positions, what are we to make of the health inequalities that are well documented in the United States? First, we must acknowledge that health is the product of multiple factors ...

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Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right? Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for those with ...

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This post continues my Ten Principles of Affordable Healthcare Reform. Health care changes should be made in small increments, easily understood by the People. Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to ...

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So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  "Mil-spec," was the phrase used ... a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me ...

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A guest post from the California Academy of Family Physicians, exclusive to KevinMD.com. Despite the slight upward tick in medical students opting for careers in family medicine over the last two years, efforts aimed at solving the primary care physician shortage are often thwarted by state and federal policy decisions. There is reason for hope, however: The number of medical school applications in California is extraordinarily high. A higher proportion of ...

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One year after passage of the Patient Protection and Affordable Care Act, the debate roars on, in Congress and everywhere else. And these debates often revolve around a big question, even when it is left unspoken or implied: Is health care a basic human right? In 1990 I made a quantum leap from practicing in the Navy’s single-payer, universal-coverage health care system into civilian pediatrics. Having been insulated from ...

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