A recent report from Rutgers University entitled "Unhappy, Worried, and Pessimistic: Americans in the aftermath of the Great Recession" found that 70% of respondents described the typical American worker as not secure in their jobs and 68% of workers are highly stressed. A quote from the study is, “The typical American worker lives in a precarious and doleful existence -- unhappy, poorly paid and fearful about losing his or ...

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I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost. Let’s ...

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In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby -- the kindly, accessible, but straight-talking television doctor -- is dead.” If he believes that, Dr. Oz needs to get out of New York. At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty schmaltzy ...

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"Patient-centered." It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple. A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned. She claimed that some patients ...

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Here we go again. There is yet another round of evidence of how the physician workforce hole we’ve dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side. One recent study appeared in Academic Medicine. Clese Erikson and colleagues surveyed a random sample of 4th-year medical students in 2010. Only 13% of the students stated they ...

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The American Heart Association and American College of Cardiology recently published new guidelines for screening and treating cholesterol. In some ways these guidelines are more like the British guidelines. Instead of setting up doctors and patients to fail by calling for certain cholesterol number targets as in the old U.S. guidelines (i.e. LDL level below 100), they instead focus on putting higher risk patients on drugs called statins and then ...

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Family physicians told us they are more comfortable with uncertainty than the "ologists." For a little history, the Future of Family Medicine project published in 2004 identified this mental attribute as an important defining skill of family physicians. This ability manifests itself across the entire spectrum of family medicine. An example is reassuring a young mother that her infant with a fever will probably be fine – and ordering no ...

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I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.

Hey Dr. Young, I’m looking for some basic mentoring advice.  I’ve been moonlighting at ZZZ Urgent Care for about a year.  Not my favorite work, but oh well.  I don’t routinely prescribe antibiotics ...

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Several physicians contribute regularly to BMJ. One of my favorites is a GP in Glasgow named Des Spence. Through their writings, I have gained a glimpse of the challenges faced by GPs in the UK, and the broader culture in which they work. In two of his columns this summer, he railed against various early detection movements in the UK. In one column, he protests against Alzheimer’s disease advocates who ...

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A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck ...

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