Like it or not, measuring physician performance is now a key part of the conventional wisdom on improving our health care system. Borrowing from management guru Peter Drucker’s mantra “You can’t manage what you can’t measure” health care policy makers have embraced performance measurement as being central to managing our heretofore unmanageable health care system.  But there is a small but seemingly growing group of Don Quixote-like dissenters who are ...

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It was recently the Affordable Care Act’s third birthday, but you might have missed it for all of the (lack of) attention it received.  Sure, there was the usual back and forth from the law’s supporters and opponents, but almost nothing that provided any new insights. Supporters, such as the liberal New York Times editorial page, marked the ACA’s anniversary by touting the tens of millions already being helped ...

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“Physicians care more about their pocketbooks than taking care of patients.  They are self-interested and overpaid.  They want to control everything.  They don’t know what life is like in the real world of patients.” By now, I am sure that physician readers of this blog can feel their blood boiling, for good reason. Why would I, as the principal staff advocate for internal medicine physicians, put such  pernicious, unfair, inaccurate quotes ...

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An elderly doctor passes away, and he find himself standing before the Pearly Gates.  The Almighty greets him and says,  “In recognition of your stellar life of service to your patients, family and community,  I welcome you to paradise.  And because I know that doctors have a great sense of curiosity about all things, you can now ask me any question—any—and I will answer it.”   The doctor ponders for a ...

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"Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying" argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post. "Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their ...

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Do we really know what is going on with health care spending? Trying to figure out what is going on with health care costs is like Alice’s adventures in Wonderland, things are just getting curiouser and curiouser. To illustrate:  which of the following statements do you think are correct? 1.    It’s been 50 years since health care costs increased this slowly. 2.    The U.S. spends more on healthcare than any other country but our health is ...

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What Lincoln can teach us about health reform “Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery.   This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many  fascinating  stories recounted in the Steven Spielberg’s masterpiece  “Lincoln” playing  ...

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Is the medical profession doing enough about gun violence? Are any of us?  This is the question that we all must ask ourselves, in the wake of the incalculably sad massacre of little school children in Newtown, Connecticut. I have struggled for days now to find the right words—how can I, or anyone else for that matter, find the words to describe the indescribable shared grief we have about the indescribable horror ...

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Worried about a government takeover of health care? You should be, but it isn’t the bureaucrats and politicians in Washington that you should be most concerned about.  Instead, it is the growing propensity of state legislators to dictate to physicians what they can and can’t say to their patients, what tests they must provide, and what advice they must give to them—the patient’s wishes, the medical evidence, and the physician’s clinical ...

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Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care ...

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