Pretty much everyone chats up shared decision making these days. And that is good.  It seems intuitive that people (patients) who are knowledgeable about their condition and buy in and/or help to shape the treatment plan are more likely to follow it. Here is an example from my seatmate on today’s flight from SFO to our nation’s capitol. Her son, let’s call him Alex, is a teen with cystic fibrosis (CF). ...

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I had a chance to “moonlight” in the internal medicine “drop-in” clinic at the Kaiser Medical Center in San Francisco while I was finishing my residency and endocrinology fellowship at UCSF.  I was superbly trained in in-patient care and there was no IV or PA line that I couldn’t put in with my eyes closed.  I was comfortable taking care of really sick people and thrived on complex, acute cases.  I knew ...

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Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform.  The results are pretty gloomy. To put this in context, it is important to understand a bit about how TDC conducted the survey.  First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company.  That means ...

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I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people.  I think the days when doctors were needed to control, interpret and dole out health data and information are waning.  There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health. The Quantified Self (QS) people who use sensors, mobile ...

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Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered. You know the old equation.  Value=Quality/Cost.  Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really). I spent almost ...

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