It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors -- in what they only half-jokingly called “Doccupy” -- that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. ...

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When looking to examine patient-centered medical home data, there’s no better place to start than the 26-month evaluation of the multi-site National Demonstration Project. Begun in 2006, with results published in 2010, this federally funded project included an array of repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months, using patients from 36 family practices that were randomized into two groups: those practices that received ...

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As the patient-centered medical homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit. And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, ...

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Patient-centered primary care medical homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care patient-centered medical home (PCMH), the more you want to ask, “Well, of course – how ...

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Drug addiction: 5 things we can learn from Cory Monteith Hollywood stars, like Glee’s Cory Monteith, aren’t the only Americans struggling with addiction that kills. Monteith, who died of a heroin and alcohol overdose, exemplifies the public health tragedy that is opioid overdose deaths in America. The fact is, there is no greater public health issue. From as far back as 2008, we have been dying more from poisoning – almost all poisonings ...

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The more complex and high stakes a health care decision is, like with genetic testing and mastectomies, the more difficult it can be to find your way. There are no “right” answers, only guideposts to help you choose a path that is best for you. Decision-making alone. When my kids went to camp in the fifth grade, they got to experience something called the Solo Hike. Counselors took them up into the ...

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There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing ...

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The first time I wrestled with the issue of whether to get my breasts cut off, I was in my early forties.  Partners in life, my breasts had done right by me. They delighted me in all their underwhelming adolescent glory. Then they’d been a source of panting, wriggling joy for so much of my adult life. They’d amazed me after pregnancy when I became a fount of Bessie-the-cow milk ...

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I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health and sustain behavior change, even in people suffering from profound mental illness. But when it comes to using these tools for public health, there are two problems. The first is that each message (whether via phone call or text) costs money. The second is that it’s quite hard ...

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Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I'd call the tenth-patient-of-the-day challenge? Here's what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn't show at the smoking cessation ...

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