Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care.  The old-fashioned practice my father and I have built is a dying entity.  Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter.  I am fighting for the survival of primary care practices.  MACRA proposed reimbursement will decimate ...

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This story has been on my mind for many years, but each time I have sat down to write it, the words would not fall into place. The other day, a family mentioned having their “rainbow baby” referring to a child born after a tragedy.  To me, rainbows symbolize that even after the roughest storm, things can get better.  To see a rainbow, there must be moisture, like falling rain, in ...

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A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury.  Thank you for your insightful article and feedback.  You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.”  You (the patient) and me (a physician) are now in the same boat, headed the same direction with the ...

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To the American Board of Pediatrics: I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my ...

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“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public.  As a PALS instructor for more than a decade, I have always responded when possible.  In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies.  A week ago, I discovered the best reason I ...

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Physicians today are not held in the same high esteem as they used to be.  We are often portrayed as callous, intolerant, clutch-fisted, know-it-alls who schedule patients around our daily golf game.  (For the record, I do not play golf.)  Physicians are accomplished in the application of science, but we are not experts in public relations. We are human beings: mothers and fathers, sisters and brothers, sons and daughters.  Like everyone ...

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Physicians are accustomed to seeing patients at the end of their lives.  It is difficult to let families know they may lose their loved one.  Clinicians are often accepting of patients DNR orders before family members are ready.  This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention.  It taught me an unforgettable lesson. During the first ICU ...

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During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child.  Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity.  His family physician pulled out the index card that served as this man’s medical record.  Yes, you read that correctly.  It was not a chart or computer printout; rather a 4 x ...

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At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago.  Sam, working at the front desk came running down onto the courts.  “There is an emergency and a woman on the phone says she needs your help.” I will be honest; I panicked a little.  My husband was home asleep as were my four children.  My thoughts as I raced up two flights of stairs ...

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Medicine can wear down our hearts and souls.  My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency.  By that final year of training, I was no longer certain medicine was really the right choice for me.  I was struggling with the notion that after almost 11 years of education, the destination was not quite ...

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