Part of a series. Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling. Why ...

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Part of a series. You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking ...

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Part of a series. We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist. That is, provided the PCP has the time to care for his or her patients with ...

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Part of a series. Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart. Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or ...

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Part of a series. “It is all about vigilance and caring. Our aim is to put the caring back into health care and we are serious about that. Our standards are not how many patients did you see today but how much quality did you dispense today,” Dr. Greg Foti told me about the clinic where he works in downtown Baltimore, MD. Individuals that have multiple chronic illnesses compounded by ...

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Part of a series. Readers of my posts know that I am a strong advocate for primary care and for granting the PCP added time per patient. Older patients in particular with both their many impairments and chronic illnesses need more time per visit. Here is an approach by a continuing care retirement community developer/manager to assure that the PCPs have adequate time for each resident, most of whom ...

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Part of a series. PCPs in the current reimbursement model are obliged for business reasons to see many patients per day which, of course, means less time per patient. PCPs are frustrated, and patients are less satisfied. With less time, it is hard to build a strong doctor–patient relationship and without it there is less opportunity to build trust. Readers of my posts at KevinMD know that I ...

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Part of a series. Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs. Those of you who have followed this series know that I am an advocate for PCPs finding ways to ...

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Part of a series. There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that ...

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shutterstock_154024799 Part of a series. I put down my blogging pen last fall to focus on two things. One was completing a new book: Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor. The second was preparing to move to a retirement community. We live in a pleasant neighborhood with nice ...

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