Doctor: “Phil, you have pneumonia.” Phil: “Oh noes. What shall I do?” Doctor: “Just take these red pills, here.” Phil: “Great! I feel better already! When can I go back to work?” Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills -- these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, ...

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The janitor approached my office manager with a very worried expression.  "Uh, Brenda ..." he said, hesitantly. "Yes?" she replied, wondering what janitorial emergency was looming in her near future. "Uh ...well ... I was cleaning Dr. Lamberts' office yesterday and I noticed on his computer ..."  He cleared his throat nervously, "Uh ... his computer had something on it." "Something on his computer? You mean on top of the computer, or on ...

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Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. My question, however, is simple. Where is the evidence that ...

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With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers. And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.) It is far ...

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A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog. To remedy our fragmented health system, reformers want to consolidate health care.  President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform.  To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices.  Today, about 39% ...

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American consumers value the freedom to comparison shop. We like to survey a variety of options and select "the one" that what we really want. If we want triple-ply, select-a-size paper towels with a blue shepherdess imprinted on them, then we expect to be able to find them in aisle 9. Deny us options and we’ll take our business elsewhere. When it comes to health care, though, endless options may not ...

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I first heard about the ICD-10 when I was working at a small start-up, trying to develop an EMR for a string of dialysis clinics. It was always spoken of with a certain gravity, like the ominous visit from an aunt that nobody in the family likes, but feels obligated to see.  Practical (read: business) people hate ICD-10. It’s giant and unwieldy. Doctors think it’ll be an excuse to bilk ...

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Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it? Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn't get coverage. Are enough people getting coverage who didn't have it before to justify the sacrifices the people who were already covered -- in the individual, ...

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We believe integrated will triumph fragmented every time. -Steve Jobs Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor. The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns ...

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The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth. The worst news is the increasing number of dissatisfied physicians. The physician, also known in the system as a "provider," has been the direct target of assault by the government. The logic has been that if the physician ...

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