If you put ten physicians in a room, you will get nine different opinions.  It doesn't matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of ...

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I have a confession to make.  The purpose of a recent blog post was to set up this one.  What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion. When I entered my first primary care practice in 2002, I had great doubts that the traditional ...

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Disruptive innovation is competitive strategy for an age seized by terror. - Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong "What do you want me to do with all the stuff in this box?" my wife asked this weekend. I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations -- a ...

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A stark reality of the past year has been the ever-looming ICD-10 transition, which ultimately got punted on by the federal government to October 2015. With the deadline to make the transition to ICD-10 now more than a year away instead of six months (and who knows if that will even be the case next summer), I’d still wager that many health systems are working to keep their transitions on track ...

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Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes. At its core, running 26.2 miles has much in common with the process ...

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As the VA scandal unfolds, with continued revelations of secret waitlists and delayed or denied medical care, calls have been building Veterans Affairs Secretary Eric Shinseki to resign. He did just that, resigning because, “He had become a distraction as the department struggles.” President Obama, eager to show America that he was being proactive about the scandal, regretfully accepted the General’s resignation. But other than allowing the president to show that he is doing something about ...

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There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids. Over 44,000,000 American children (more ...

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Reduce health costs? Stop focusing on physician salaries.My latest USA Today column is now up: Doctors are not overpaid. I explain why focusing on physician salaries won't do much to dent health costs. Also, as I wrote in a prior blog post, "Pay me like a French doctor. You know you want to," any salary comparison with other countries also needs to consider their costs of medical education ...

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The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation. In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan. Yet our measurable health outcomes -- from infant mortality to life expectancy -- aren’t any better than nations spending much less. I’ve written about this paradox before, pointing to a few ...

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Taking a page from firefighting to fix health care In firefighting, pump physics is one of the most critical things an engine company officer must understand.  How do we "get the wet stuff on the red stuff" in sufficient quantity without sacrificing penetrating power? The inverse ratio between volume and pressure (as the water pressure increases, volume decreases) has befuddled many a rookie lieutenant. The same, I think, is now true ...

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