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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shutterstock_74638591 You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in the New York Times headlines the Department of Health and Human Services (HHS) have been wanting you to read. And, this is how it’s working ...

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There’s nothing like discrimination -- true or imagined -- to keep our airwaves humming. Recently, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom. Yes, I know the other side of the argument, that these religious freedom protections were veiled attempts to discriminate against the LGBT community. Both states raced to revise their original laws, although the laws' backers deny any discriminatory intent ...

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A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way. The guy -- Steven Keating -- is not your average Joe. He is a ...

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How to Win Friends and Influence People by Dale Carnegie is a timeless bestseller. It is a book that’s translated into many languages globally and carries brand name recognition.  People who read the book recognize common sense approach and simple lessons of courtesy that are so eloquently described by the author. Dale Carnegie had a knack for oratory skill and displaying genuine connection with other human beings. While he tried many ...

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$28 million was awarded to a patient for a late diagnosis of a pelvic tumor, an osteosarcoma. This rare cancer presented as a case of low back pain and sciatica. The patient claimed that if the osteosarcoma had been caught earlier that the subsequent surgery would have been avoided. Could doctors have done better in diagnosing more quickly? These cases strike fear into all primary care doctors. Which patient has a ...

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America faces a serious shortage of primary care doctors. The reasons are not hard to understand. Lower income is the most important factor.  Adult primary care doctors (general internal medicine physicians and family medicine physicians) earn on average $100,000 or so less per year than specialists do. Our income is much greater than that of the average American, and so many people have little sympathy here.  But almost all people prefer ...

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shutterstock_169107956 I can’t mention the physician by name, because he is currently in contract negotiations.  But he lives and works in a Midwestern town of several thousand people, a town where the major social event of the year is a fall festival that features a parade down Main Street.  The physician, let’s call him Dr. Smith, has been practicing there for nearly ...

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Many people know what it feels like to be depressed. It’s hard to go through life without at some point experiencing that helpless/hopeless feeling. Some people, however, stay stuck in this painful state. In my family therapy practice, I frequently get calls from people seeking help for depression. Sometimes their depression is self-diagnosed, reflecting their experience of ongoing distress.  Other times they’ve been referred by their family doctor.  It’s common ...

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I often get referrals from the town's free clinic.  As you would imagine, the patients often have a unique set of problems, coming as they do from the underserved segment of society. One such patient, Julia, was a fiftyish-year-old woman who had recently moved to town from California. She went to the free clinic (not really sure what the original complaint was) and ended up getting a physical exam that revealed ...

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I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine. If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics: 1. Team leadership. Every doc is a leader to some degree, ...

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An excerpt from The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital. The outdated caricature of the sexy nurse -- breasts straining buttons on a form-fitting white minidress, shapely legs slipped into white heels -- remains pervasive and global. Nurses say it also holds the profession back. Imagery that sexualizes nurses presents a difficult job requiring ...

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Americans are waking up to the fact that the $170 billion that Medicare spends on the last six months of life is not helping us die well. Instead, the way we die today tends to be protracted, undignified, and painful. Sarah Palin’s “death panel” debacle temporarily stifled all discussion on the subject, but the silence has been broken by dialogue inspired by the Institute of Medicine’s recent report, Dying in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and ...

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shutterstock_121457908 Let's face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience.  The emotions run from jubilation to sheer terror. It is inevitable that some of the people you interact with will leave a lasting impression. In the case of the ...

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“55-year-old man with history of laryngeal carcinoma, status-post radiation therapy, laryngectomy, bilateral neck dissection, with metastases to the lung, status post thoracotomy, currently undergoing chemotherapy who is being admitted for a for first-time seizure. Patient is a transfer from Riker’s Island.”
Prisoners are a common occurrence in Bellevue Hospital. This, however, was my first prisoner-patient. The hyphenation both as I write this now and as it formed as a concept in ...

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About a year ago, there was a great commercial that depicted the slowing of time as a free-falling, but worry-free, James Franco uses his smartphone to chart a safe landing on the billowy awning of a restaurant dozens of stories below.  There probably isn’t a single person who hasn’t, at one point or another, wished she or he could control time in order to navigate a better outcome.  And doctors ...

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It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. ...

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In India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital. He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his ...

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shutterstock_84146302 I drank the Kool-Aid early.  We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling.  While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.

  • Within a year of implementation, our practice became one of the top installations for our vendor.
  • Within two years, ...

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