Physicians and patients are fighting a growing hypocrisy in American medicine. Examples abound, such as criticism that doctors are overprescribing antibiotics and contributing to resistance, while insurance companies simultaneously incentivize their members to use telemedicine programs or urgent cares instead of visiting their primary care physician. My own insurance company, Cigna, recently sent me a letter notifying me that I will have a reduced co-pay if ...

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Dear patients, One year ago, I wrote to you about my concerns for the future of my practice in light of upcoming changes to the Medicare system.  I explained my anxiety about the Medicare Access and CHIPS Reauthorization Act (MACRA), a change in fee structure from fee-for-service (I treat you in the office, submit the bill to Medicare, and they pay the bill), to “value-based” payment (I treat you ...

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With the latest data calculating physician burnout at greater than 50 percent, American medicine is at a tipping point.  How to fix this crisis?  Why, make physicians more resilient, of course! Except physician resiliency is exactly what got us into this problem. Let me explain.  Doctors are notorious people pleasers.  We spend years of our life at study, sacrificing the fun and freedom of youth, deferring childbearing, and delaying ...

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I recently saw the movie, Captain America: Civil War.  If you haven’t seen it yet (no spoilers), the United Nations decides that because of civilian fatalities during previous Avenger battles, the world would be safer if all superheroes voluntarily subjugate themselves to the authority of an organized government body. Sounds good to some of the Avengers; after all, innocent people have died, and maybe some form of supervision will minimize collateral ...

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Like many physicians, I’m a people pleaser.  On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering -- and I really meant it.  What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically. Medical school and residency didn’t adequately prepare me for the emotional strain of ...

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I have a dream job. I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday.  I’m off Friday through Monday, and I don’t take any call.  I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety. It wasn’t always this way.  Like all new doctors recently out ...

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Dear patients, This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away. As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of ...

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Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy. The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us.  Studies show ...

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