For a moment, let's forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not. I would rather, however, look at how Donald Trump in the White House might affect the day-to-day lives of physicians. And by this I am not referring to his support or opposition to universal health care, for I ...

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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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A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested For those who are unaware, "bundled payments" means that ...

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We all accept that we can't vote until we are 18 and can't order alcohol -- at least legally -- until we are 21. We know that if we speed 60 mph in a 45 mph zone, we risk a traffic ticket or accident. We get used to these numbers and pretty much know the risks if we break them. However, the practice of medicine is becoming more and more ...

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On July 1, 2014, I retired after 35 years in practice. Or at least so it seemed. Before and after retirement, my cardiology group asked if I might be interested in part-time work. At first I said no. Due to my retirement, a physician's poor health, and one partner's departure due to chronic complaints of being overworked and under-appreciated, the group found itself without three doctors. As my retirement approached ...

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Having just retired on July 1st, my medical group's commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap. I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has ...

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This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient's arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is ...

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Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like ...

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Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital -- ever. (I am retiring from medicine in ten weeks.) I certainly wasn't there for the food, although the fare was much better than the daily servings in the doctors' lounge. Part of the night's agenda was a rousing talk by the hospital's new chief medical officer (CMO). A retired surgeon, the CMO ...

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I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician's progress note. To be sure, these notes, even the now "ancient" written ones, were far from perfect. And they were often illegible. Shortcuts such as "as above" or AVSS (all vital signs stable) littered the pages of the ...

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