The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?* The questions followed ...

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Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death costs a lot, and society can go broke providing costly medical care to everyone. Society saves money and lives when everyone sees a primary care doctor who works to keep people well. But we don’t and won’t have enough ...

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Is Physician “Shadowing” a Shady Practice? asks Dr. Elisabeth Kitsis in a post at the Doctor’s Tablet, a blog run through the Albert Einstein College of Medicine. She concludes that yes, it is, and invites readers to share their opinions on having high school and college students shadow physicians. I was reminded of my fantastic 8 week shadowing opportunity as a college student through the Project AHEAD program at the 
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I advocated for the Affordable Care Act, and celebrated when it was passed. It’s good to have everyone covered, I thought. Insurance for everyone is the first step to health care for all. Alas, access to health insurance isn’t the same as access to health care. First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for ...

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Three out of four dentists recommend this tooth brightening toothpaste -- make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger -- make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States -- make your health care system heal like never before! But how do we do that? Do doctors think the Affordable Care Act is the soothing balm ...

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Who better knows how to fix a leak than a plumber? Who better knows how to repair a cracked doorway than a carpenter? Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor? Doctors are an important part of public discussions about health care reform.  Our prescriptions drive healthcare costs.  We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care ...

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The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care. This struck me as odd when I first read it.  Why should the stated aim of any system become to decrease the costs associated with that system? Which led to the next logical questions: What should be the stated aim of ...

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“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had  worked all his life as a plumber with no health insurance.  When he was healthy, it was okay.  But now he was sick. I was meeting him for the first time in the community health center where I work as a family physician, tending ...

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When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.  His untreated diabetes made his feet go numb.  He stepped on a nail and didn't realize it until he noticed a smell that cost him his foot. He spent thousands of dollars on the surgery and subsequent hospital stay—far ...

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Pay for performance.  It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more. What could be simpler, right? Wrong. Not all patients are created equal.  Some are highly educated, highly literate, highly motivated to prioritize health.  They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying ...

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