People lie. Patients lie.  Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear. A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on.  Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all. Providing primary care to patients on the furthest margins of ...

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Stopping prescription drug abuse starts with primary care As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America - up to five times higher than the national average.  Our patients routinely lose family to addictions; our clinic has been home to a ...

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Health reform includes measures to link hospital reimbursement to patient satisfaction measures.  Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future. Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure ...

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