In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical ...

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When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to see my 30s if the world continued its march toward nuclear Armageddon. My father refused to even have the discussion. I’ll get to why he refused in a minute, but first, a bit of ...

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The new school year is just around the corner (or maybe it’s already started where you live). Either way, here are a few quick tips to make sure you start the year off right: 1. Sleep is key: Poor or insufficient sleep can have significant effects on school performance. Many of us (myself included) let our children stay up later during the summer months. But as school starts back, it’s important ...

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"I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I'm disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, ...

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We all want this sometimes, don’t we?  We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away.  But how often does that really happen? As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it's MACRA ...

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A colleague of mine was recently questioning her capabilities having lost yet another patient who had arrived nearly lifeless after being shot.  She was despondent over the nation’s overall complacency about our gun violence epidemic giving her far too many opportunities to fail or succeed as a trauma surgeon. Truthfully, neither quick, decisive action nor expert surgical skill was enough to repair that much damage. Not in the hands of any trauma surgeon. As ...

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Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning ...

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screen-shot-2016-08-16-at-5-08-11-pm Donald Trump is talking about Hillary Clinton’s health as are two doctors who have never evaluated Clinton. This attention on Clinton has renewed some interest in the letter Donald Trump released last year from his personal physician. Many outlets have picked it apart, but I want to tell you as a doctor exactly how bad it is. I would never write ...

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During my first rotation of intern year, we took care of a woman who walked into the hospital with a kidney stone and never walked out. 52 years old, diabetic but otherwise healthy, she had been vacationing in Vermont with her son and extended family when she became sick with high fevers. When her symptoms didn’t improve, her son rushed her to our emergency room where an imaging scan revealed ...

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I graduated medical school in 1995. I believe in a single-payer health system. I am about championing for my patients. I left a salaried position in academic medicine to go an underserved area of rural Maine and start a practice. This is the letter I wrote to the CEO of a large health insurance company recently. Dear Mr. CEO, My name is Cathleen Greenberg London. I am a family medicine physician who ...

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The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll and Austin Hill, the architects of modern epidemiology, realized that it was hard for epidemiology ...

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"Z" and "S" were both hesitant skeptics from the start. Earlier this year, they’d signed up for an entrepreneurial class I taught. Z was a first-year medical student with a dream of having millions. S was his blonde-haired, model-type wife; ex-ballerina-come-cancer-survivor who wanted to help people with similar experiences. Before the course, she’d contemplated taking out even more debt in student loans so she could go into physical therapy.  After the course, ...

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Years ago on Cape Cod, my kids and I stumbled across a man who had spent the day creating a sand sculpture of a mermaid. It was an impressive piece of art. “How long did it take you to make it?” we asked. While I can’t recall his precise words, the response was something like “25 years and 7 hours.” I’m sure my astute readers will get his point. We are transfixed ...

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2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime. My first night in the unit and my first patient’s chart.  Papers spill from the accidentally opened binder ...

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Living in the fine city of Boston, I am fortunate enough to be located right in the middle of a medical hub. A place that’s full of exciting new research, developments, and ideas. Working at the front line of hospital care, also with a keen interest in quality improvement, patient experience, and technology, I frequently attend social and professional healthcare networking events around the city. While doing this, I’ve gotten to ...

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“Get well soon!” That’s a common saying. All of us have heard it. But what if you have an illness that you won’t ever get better from? The most horrible part of having a chronic illness is that it’s forever, or for a very long time. Unless your personal miracle comes, your illness will always be with you. There isn’t an end in sight. There’s just adjusting to the pain, the tiredness, ...

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To my younger self, I remember how excited you were when you finally settled on medicine as the thing that you wanted to do as a career in your junior year of college. I remember all the questions you had about what the process entailed since no one in your family had undertaken this journey before. I even remember some of the doubts you had when you thought about how long ...

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Many recent articles, blogs, and presentations have focused on what American health care lacks and what additional skills health care professionals should adopt to “fix” our “broken” system. Third-party payers and health care organizations tend to promote the need for quality improvement and economic measures, while clinicians grapple with their transition to less-autonomous employees, noting increased job dissatisfaction and conflicts regarding administration and reimbursements. The theme that American health care ...

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A.J. Smith, a pseudonym of course, walked into my office today, unhappily.  Most of her topical medications for acne caused too much irritation.  The ones that didn’t, weren’t working.  The doxycycline caused photosensitivity in the past.  But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared.  As such, that’s what my patient demanded.  There was only one problem.  The degree of her acne didn’t warrant ...

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The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians. WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary.  This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation. Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, ...

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