According to the American Medical Association, there were approximately 685,000 physicians in patient care, post-residency, not employed by the federal government, in 2012. 60 percent of these physicians practiced in independent private practice, and 84 percent were working in small to medium size practices. Assuming that the trend to employment of doctors by health systems continued unabated to this day, over half of practicing physicians are still in private ...

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Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any ...

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Remember when we were trying not to panic about Ebola? Seems like that was only yesterday. Oh wait -- it was only yesterday. But it already seems as if we are trying to remember that we were trying not to panic. I listened to my favorite news radio station out of New York City while driving to the office recently. They address all of the major news stories in the first eight ...

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Information technology clearly has a long way to go before it delivers on the immense promise of technology to truly improve health care. Most of the current solutions -- quickly rolled out in response to meaningful use requirements -- are slow, inefficient and cumbersome. Physicians (and nurses) spend far too much time staring at their screen and navigating the system, often to the detriment of patient care time. A study published last ...

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Walk in the shoes of a cancer patient We sit, we listen, we attempt to focus and absorb what we are required to know. We learn how to give bad news, even using one another as makeshift “standardized” patients. How does one “standardize” a patient anyway? Who knows, who cares, time to cram for the endocrine exam. But what happens when you stop pretending? When you wake up one morning ...

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Top stories in health and medicine, November 17, 2014From MedPage Today:

  1. Ebola: Signs of Progress, CDC says. The response to the Ebola outbreak in Liberia is showing encouraging signs of progress, with downward trends in new cases especially in two regions of the country that had been hot spots.
  2. Millions Of Medicaid Kids Missing Regular Checkups. Millions of low-income children ...

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Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not ...

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It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket. They call these messages "system notices." OK, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic ...

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Patients are doubly screwed by the malpractice system Part 3 of a series.  Read part 1 and part 2. The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. "Ho hum," says a lawyer who read my first two posts in this series. "Get out the violins." It's as if, because I make my living operating on ...

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Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, ...

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Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. - Susan Sontag, Illness as a Metaphor Words are important. ...

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Need better care coordination? There’s a toolkit for that.A guest column by the American College of Physicians, exclusive to KevinMD.com. Care coordination seems to be the rage these days. It is mentioned in most discussions of new delivery and payment models such as the patient-centered medical home (PCMH) and accountable care organizations. The concept is not a new one; primary care physicians have been coordinating care ...

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Patients: Accept your fate as a hamburger Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units. The name of the game today is efficiency -- i.e., ...

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Jewish history has all too often been written in tears … I am fascinated by people and groups with the capacity to recover, Who, having suffered the slings and arrows of outrageous fortune, Are not defeated by them but fight back, Strengthened and renewed. - Rabbi Jonathan Sacks, PhD,To Heal a Fractured World In some situations, the whole idea of complete recovery from bereavement makes no sense.  Bereavement can be fully expected to last a lifetime.  ...

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Terrifying truths about health care IT One would expect that in an era where smartphones are more powerful than our computers were 5 years ago, health care providers would have an arsenal of health care IT solutions to enhance patient care but also optimize their own workflow. Shockingly, in 2014 most health care IT solutions (such as EHR systems) are incapable of basic functions that we take for ...

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What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, ...

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When is it right to share our personal struggles with patients? I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. ...

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I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift ...

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What primary care can learn from the financial service industry Man looks into the Abyss, and there's nothin' staring back at him. At that moment, man finds his character, and that's what keeps him out of the Abyss. - Lou Mannheim (Hal Holbrook) in the movie, Wall Street We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health ...

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