By now you’ve surely heard that Medicare is going to pay doctors and other qualified health care providers for advance care planning with patients in 2016. Aren’t you excited? OK, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and ...

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At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that, “The meaningful use program as it has existed will now effectively be over, and replaced with something better,” and later clarified on Twitter that, “In 2016, MU as it has existed-- with MACRA-- will now be effectively over and replaced ...

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In 2013, I wrote a post, "How Can Physicians Retire Gracefully?"  Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I thought it was time to revisit my thoughts and predictions. I have been able to keep structure to a minimum. I go to tai chi classes two to three ...

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Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician. During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, ...

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While I recognize that I have a better chance of contracting dengue fever in my suburban city than there is of you actually reading this, I will try anyways. Here it goes. My name is Megan. I am a family medicine doctor practicing in Northern California, and I love my job.  I'm nothing fancy. I don't spend my day in the OR. I don't spend my day in the emergency room ...

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During medical school, we are taught the physiology, anatomy, and pathophysiology of hundreds of disease processes. One thing medical schools don’t teach well is how to cope with losing a patient. Some physicians will go many years as a physician before having their first patient die on them. Others will lose a patient earlier on during their career. I was the latter. I hadn’t even graduated from medical school yet ...

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I’ve been asked previously what I think is the biggest challenge facing medicine or surgery in the future. Many physicians and futurists would suggest that personalized medicine, genetic therapy, cancer cure, public health, nanotechnology and many other things are going to form several of the biggest challenges ahead of us. The more I spend time in medicine and surgery, the more I reflect on the future of medicine, the more I ...

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There has been on average one mass shooting (involving at least 4 people) for every day this year. In the wake of the San Bernardino shooting -- the most recent widely-covered mass shooting, America has reopened the debate over gun control, pitting a bereaved public beckoning for gun reform against strict Constitutionalists. Yet, in this polarizing debate filled with a seemingly binomial future, there are other options: Namely ...

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A few months ago, I came across a young man who had come in with increasing fatigue and shortness of breath that was limiting his quality of life. As a barber, he looked forward to cutting hair and talking with his clients about the events that were happening in their lives. On the surface, it appeared that things were going well for him overall, but people were not aware that ...

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Computed tomography (CT) is a powerful diagnostic tool that allows rapid diagnosis of disease.  CT is widely available in the U.S. and is a mainstay of medical diagnosis.  Estimates state that 85 million CT scans were performed in the U.S. in 2012.  To create images, CT scanners pass ionizing radiation (x-rays) through the body thereby exposing patients to radiation.  Patients who are imaged with CT have a theoretical ...

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I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer. Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened. A study found a higher incidence of breast cancer with ...

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What does a 3 year old know? If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds.  The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a  doctor at that age all the more amazing.  But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to ...

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An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time. I’ve studied lots of industries. In general, cost and quality compete on equal terms. Some companies emphasize cost, others quality, but both are always in the picture. And then there is health care. Uniquely among industries, health ...

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Earlier this year, when my mother was briefly hospitalized, nobody gave her the wrong medication (her wristband was checked before each medicine was dispensed).  Nobody missed a high or low blood pressure (her vital signs were taken every few hours, like clockwork). She was usually assisted to the bathroom so she wouldn’t fall (a sensor on her bed triggered an alarm if she started to get up). Thank goodness for hospital-based ...

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Part of a series. You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking ...

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Dead babies aren’t something anybody likes to talk about. But while it may be an uncomfortable topic, it’s also an important one -- because there are things we can do to make it happen less frequently. The loss of an infant is something parents never really get over, and something that no parent should have to experience. Here’s a look at the most common causes of infant mortality and some things you ...

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How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health. I can’t throw any stones here. Even a physician has knowledge that is limited to his or her ...

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I love being a pediatrician; there's nothing I would rather do. But sometimes I get frustrated by things that parents do -- or don't do. I'm not talking about things like being late (hey, I run late, it would be unfair to complain), or getting upset with the staff about waiting (hey, I'm going as fast as I can and what if it were your kid who needed more time?), or ...

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Walter was far older than his chronological age.  A mere thirteen years, he kept company with a much older crew.  Doctors, nurses, and CNAs were his constant companions.  The other kids on his floor were either too sick to interact, or came and left within a matter of days.  But not Walter.  His heart was too weak to allow his departure, but too strong to be first in line for ...

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My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better ...

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