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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I’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state. The issue of cost came up and two colleagues in private practice told ...

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Doctors love to talk about tort reform – states passing laws to put limits on awards such as non-economic damages for harms such as pain and suffering, and on the legal process of suing a doctor for malpractice. They speak of defensive medicine – the practice of ordering extra tests, treatments, and days in a hospital to cover their medical-legal butts. Texas passed a comprehensive tort reform law in 2003 ...

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I love being a family physician. If I had to do it all over again I wouldn’t change a thing. I love the breadth of family medicine. I love being able to take care of just about every person that walks through the door. Even when another doctor is the right person to take care of a niche need, I love knowing that I was usually the person that ...

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Paul Grundy is IBM’s Director of Healthcare, Technology and Strategic Initiatives for IBM’s Global Well Being Services and Health Benefits. He has led the development of the Patient-Centered Primary Care Collaborative, which is leading the way to create a more efficient and responsive healthcare system. Before I go any further, let me be very clear by saying that his work is hugely important and I agree with 90% of what this ...

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