If you put ten physicians in a room, you will get nine different opinions.  It doesn't matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of ...

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I have a confession to make.  The purpose of a recent blog post was to set up this one.  What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion. When I entered my first primary care practice in 2002, I had great doubts that the traditional ...

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It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look. The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered ...

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It is time for American physicians to rise up It's time for the American physician to stand up. We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs ...

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He was rather tall.  Or at least he appeared so with his long erect back jutting from the bicycle seat. The cringe worthiness of his helmet-less head was assuaged by the gigantic headphones covering his ears.  I figured they would provide minimal protection during a crash, but at least he would be listening to groovy tunes. He weaved in an out of traffic on a busy two lane road.  He peddled ...

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It's not that I was stressed out about being alone with the kids.  My wife had gone out of town before. It was the darn mornings.  I'm used to racing out of the house at the crack of dawn, when the rest of my family is still asleep.  My most productive hours of the day are before most people even wake up.  With my wife gone, the mornings with the ...

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The process of becoming an excellent physician is one of mastery.  The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult.  The leap from decision to clinician takes decades.  Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues. The apprentice guards his knowledge closely.  He bows to the alter of the sacred skill that he ...

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I have often spoken of the doctor-patient relationship as a covenant. Our patients bear their bodies and souls in exchange for a thoughtful, engaged, respectful partner in navigating health and disease. This dyad, this trusted space, allows for the breaking of cultural norms and full disclosure.  Proper healing is an agreement, it is a relationship. Although often not spoken of, any successful flourishing health care system also requires another ...

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When someone asks me about what it is like to be a doctor, a funny thing happens.  My eyes start to water and the words catch. It's rather comical how emotional I can be.  I have been all my life.  I sometimes feel the sadness flow through me.  I am a sieve.  Whether it be a touching book or a sappy TV commercial, I cry.  Silently.  Often missed by others in ...

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According to a study by Jackson Healthcare, the percentage rate of U.S. physician compensation is among the lowest of western nations.  In 2011, physicians' salaries compromised 8.6 percent of the nation's total health care costs.  This is in comparison to 15 percent in Germany, 11 percent in France, and 11.6 percent in Australia.  Detractors point to the fact that although the percentages speak for themselves, if you look at ...

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