I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn't reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let's just say that it has quite a kick. These thoughts jostled through my mind this morning as I pulled into ...

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Johns Hopkins ophthalmologist Oliver Schein has found a simple way to save a half a billion dollars a year from our country's health care bill, with no negative effect on patient health. The only thing standing in the way is a stubborn government requirement. Seventeen years ago, Dr. Schein and colleagues published a study finding that cataract surgery patients who underwent routine preoperative testing -- such as ...

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With the ruination of American teaching using “value-based” purchasing and payment concepts virtually complete, the U.S. government is now training its sights on medicine with similar intentions. With the new MACRA pay-for-performance program, CMS bureaucrats believe they can force health care providers to practice better “quality” care by collecting clinical performance, practice-related, and cost data, and basing payment increases and penalties on the results. There is one big problem associated with ...

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Although every technology product released today seems as if it is “powered by artificial intelligence,” the actual AI revolution is ahead of us. When it arrives, it will be on par with the industrial revolution in changing our lives, especially in the world of medicine. John McCarthy, a legendary computer scientist, coined the term “AI” in 1955. He defined it as “the science and engineering of making intelligent machines, especially intelligent ...

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An excerpt from Confessions of an American Doctor: A true story of greed, ego and loss of ethics. The Medical Board of California attorney, Mr. Arnold, proceeded to read the discussion I had with the undercover agent regarding the source of the human growth hormone, including the ...

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For many centuries medical practice was a black art. What physicians did was based upon theories of how the body worked that turned out to be fanciful at best, dangerous at worst. The late nineteenth century brought breakthroughs in the biological sciences, such as the identification of bacteria and new understandings of physiology, which increasingly placed medical practice on a scientific basis. That process has continued over the past 150 years, ...

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Now, I’m just a country doctor, but I have to say I find it very hard to understand why folks in this country, on one hand, keep talking about a doctor shortage in primary care and, on the other hand, keep piling sillywork on those of us who are still here. The net effect is that the doctor shortage is going to be a whole lot worse than it has to ...

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Now more than ever, health insurance is a staple story in the 24-hour news cycle. Opinions vary widely on the issue, as do politician’s thoughts on the matter. Debates rage, tensions grow, and deeper divides are formed as our government wrestles with this colossal dispute. Nestled at the heart of it all though is a basic question: Is health insurance a right or a privilege in the United States? I’m alive today ...

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My friend and neighbor died last week.  In his early eighties, wiry, opinionated, well-read, he never tolerated schooling. He built an excavating business with a perfected aesthetic for contouring soil and also built a few homes in town including mine.  When he saw the architect’s lower pitched roof framed on the garage, he had it torn off because: “It just wasn’t right. It looks like a tiny bowler hat on ...

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I have lived for some time with depression. Most of the time, it is nagging in the background, helped by exercise, family and friends. But a few times, despite my best efforts, it has gotten out of control. At the middle of my chief year in November, it came to a head. I was under tremendous pressure to apply for fellowship when I didn’t think it was what was best for ...

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During a recent internal medicine rotation, a senior resident expressed disappointment that I've chosen a career in family medicine. He was concerned that my talents would be wasted, because -- in his words -- I wouldn't get to care for the "more complex patients" he sees in internal medicine. Although I appreciated his confidence in my abilities, I felt my heart sink, as it does each time I am faced ...

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Women surgeons all over the globe have been recreating the “Operating Theatre” cover of the New Yorker through the #NYerORCoverChallenge. The public recognition of women in what has been a male-dominated field has rallied female surgeons’ spirits everywhere. Except, perhaps, mine. While I am fiercely proud of my surgical sisters, I also feel a twinge of sadness, because I know so many of the untold ...

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He could not stand Legs weak from the wasting effects of a cruel disease Stripping him of his manhood Denying him his future He could not eat His mouth cracked and dry Saliva having made an untimely exit from his personhood Unable to return again He could no longer dream He would say As I stared at him Longing to do more than hope that his pain patch Would lessen the pain of not just dying but of knowing one is dying. When ...

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While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in "Platoon." And medical professionals are dropping f-bombs. All of ...

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When Lorie Duff was pregnant with her third child, she did what all good moms are supposed to do. She went to the OB/GYN clinic for prenatal care. But she fell behind on the clinic payments. She only made about $25,000 a year managing an auto parts store while her husband stayed home with their kids. The out-of-pocket expenses were outpacing her ability to pay. That’s when she ...

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Nearly 30 years ago, I attended the labor of a Vietnamese woman on an island off the coast of Thailand. The woman had malaria. She died a few hours after giving birth to her stillborn child. That experience has never left me. It has fueled in me a passion for global health, and especially for alleviating suffering and death from tropical diseases such as malaria. It is also worth remembering, however, that ...

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I hope you read this letter. I doubt you will. I know you’re busy rebuilding Washington, reshaping the international order and doing a lot of other weighty stuff.  Full disclosure, I voted for you.  Not because you promised to repeal the Affordable Care Act, or because you tweeted at me about it, but because our health care system is hopelessly broken and requires an overhaul that does not simply convert ...

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It was the end of my third year in OB/GYN residency. I was 39 weeks pregnant with you and doing a hysterectomy, my gravid abdomen being utilized as an “extra hand” to displace the large clamp nicely to the side as I pressed my belly gently against the table. I was doing surgery all day and loved operating and feeling your occasional gentle movements when in the quiet operating room as ...

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There is enthusiasm in politics about reducing regulation to stimulate creativity and economic growth. Maybe. But reduction in oversight of medication and medical devices by the Food and Drug Administration (FDA) will probably lead to a proliferation of expensive potions and gadgets that don't actually help. The New England Journal of Medicine published an article detailing the near miss associated with an injectable monoclonal antibody for Alzheimer's disease. ...

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The American health care system is broken, but it is not really “health care” that is the problem.| The science of medicine, the tests, and the treatments available are better than ever. It is health care bureaucracy that is the problem. But doctors, nurses, and patients bear the brunt of the dysfunction. Medical professionals are unable to practice, and patients are denied the care they need, even though it is readily ...

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