Part of a series. There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that ...

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Eleven billion dollars. Sounds like a lot of money, doesn’t it? It is. But, I’ll give you even more perspective, Tony Robbins style. Eleven seconds ago you started reading this page. A few blinks of an eye. But, eleven million seconds? That was a few months back. 127 days to be exact. Can you remember what you were doing then? Eleven million seconds have passed since you did it. But, when you jump to billions, you’ll ...

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I recently attended (and spoke at) the Concierge Medicine Assembly in Atlanta.  My role was to give the perspective of a "successful" direct primary care (DPC) practice.  This being the second such conference in three weeks, I've learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices.  The Atlanta conference was actually a combination conference, catering to ...

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test9 copy It's time to celebrate diversity in surgery with the #ILookLikeASurgeon hashtag. Inspired by surgery resident Heather Logghe, who says it best: "As women surgeons, whether we are in our first year of training or an emeritus professor, it's most important that we ourselves believe we 'look' like surgeons. Because we do." And it's taken off. Below is a continuously-updated Storify of this movement. Spread ...

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shutterstock_110533634 Imagine the scene: You’re in your busy office on a typical day when a letter arrives -- a letter of intent. A patient is suing you for malpractice. From the moment you receive that letter, everything changes. The malpractice claim begins to affect all aspects of your life. You don’t sleep well. You don’t interact well with family members, friends, or colleagues. You ...

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shutterstock_169451723 Dr. Google wants you to think he is your best friend. He is there for you day and night, no waiting rooms or office hours needed. He promises answers, and he gives them now. No testing, no lab draws. Dr. Google provides diagnoses after a few clicks on a keyboard and delivers the news in minutes, if not seconds. Dr. Google will ...

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shutterstock_227448991 Being an intern and resident in today’s day and age of medicine is proving to be more difficult than ever. I’ve written about resident work hours before, but now that I have finished intern year, I have a lot more to say regarding this issue.  I recently reread Dr. Pauline Chen’s article "The Impossible Workload for Doctors in Training," ...

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asco-logo I vividly remember meeting her, despite all the years that had passed. At 6 feet tall she towered over me (granted, anyone who has met me will know that’s not hard to imagine) and yes, I’ll admit it -- she had physically intimidated me. But about 10 minutes into the initial consultation, I realized she was soft-spoken, kind, and, ...

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shutterstock_153221729 “Patient experience. I’d like you to take over the initiative,” he said. I looked to my left and right. Sh*t. He’s talking to me. For a moment, I had an overwhelming sense of insecurity. Give me operations. Give me finance. Give me quality. Give me strategy. But don’t give me patient satisfaction. That’s not me. I’m not light and fluffy. I’m not mushy-gushy. Nor ...

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shutterstock_204483163 One of my favorite books of late has been Confessions by St. Augustine. It is a very honest book that talks about the development of the faith of a young man who struggled to accept the faith that he was raised in. Throughout the book, one can sense the inner turmoil he felt at times trying to reconcile his faith with the ...

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Kevin-Dietl-crop-2 Medical school graduation: Time to celebrate our brand new doctors! Except for the families who can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday -- ever again. Like Michele and John Dietl. They lost their son, Kevin (pictured above), just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why? I’ve become a sideline specialist ...

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shutterstock_196751390 There's an awful lot we don't know about the effects of screen time on babies and toddlers -- which is too bad, as babies and toddlers get an awful lot of it these days. We don't know if watching TV or using tablets or smartphones will turn them into violent zombies, make them brilliant computer scientists, do something in between or do nothing ...

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shutterstock_273641858 Like many practicing general surgeons I read with interest the recent Finnish paper published in JAMA that attempted to challenge the long held surgical dogma that the best treatment of acute appendicitis is cold hard steel.  The paper itself, in terms of design, was beautiful.  This was no retrospective review of a series of case studies.  This was a ...

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shutterstock_154181867 The most important factor in successful stroke treatment is time. When a stroke patient is encountered by EMS, or when they present to an emergency department, it is absolutely vital to determine the time "last known well" to make decisions about what treatments may be available and appropriate. A 97-year-old woman arrived in our emergency department after suddenly becoming unable to speak, and ...

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shutterstock_69679648 "There's no crying in baseball!" Over the years, my fellow surgery residents and I heard these words shouted countless times by Dr. Norris, a cantankerous elderly surgeon with whom we had the dubious pleasure of working. Dr. Norris was a former Navy ship surgeon. He didn't operate much anymore, but he fondly remembered the "good old days" when trainees spent days on end in ...

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shutterstock_260657870 What does a millennial physician look like? And, importantly for physicians’ groups, hospitals, and health systems, how do you effectively recruit them to come work for you when they are in such high demand? Much has been written about this generation of overeducated and underemployed young people -- all full of entitlement and purpose -- who have been transforming values and expectations in ...

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shutterstock_208716340 I have been an emergency physician for 12 years.  I have had the opportunity to learn from and try to emulate an impressive number of amazing clinical physicians.  These doctors seemed god-like at first, but as my training and career progressed, I realized that they were mostly teaching me through their own experiences. One of my favorite teachers had a humbling saying:  “Good ...

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shutterstock_153912641 Recently I have been reading articles regarding the patient experience that I find both stimulating as well as challenging. As the chief experience officer at Massachusetts General Hospital (MGH), you might imagine just how many times these articles are forwarded to my inbox when they are published. In “The Problem with Satisfied Patients” by Alexandra Robbins in April’s edition of The ...

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shutterstock_125996114 As kids growing up in the Midwestern United States, my friends and I loved baseball.  We spent many hours each summer day playing the game, and when we weren’t out on the sandlot, we were reciting the stats of top players, arguing the merits of our favorite teams, and trading baseball cards.  Baseball is more than America’s pastime.  It is a sport ...

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shutterstock_144352681 Recently I met a boy, a boy with leukemia, a young boy with comic-book worthy superpowers. This boy, this superhero, is one I will never, never forget. When I entered the exam room, I was immediately struck by the sight of a young boy who should have been playing football with his friends at the park or jumping off the high-dive at the pool, but instead ...

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