Why the VA scandal is a red flag for single payer advocates "I will not stand for it.” That’s what President Obama said about the deepening VA health care crisis.  It’s also a lightening rod for how partisans want to frame the ongoing health debate. Some are eager to link the VA scandal to Obamacare, and more broadly, government-run health care. Others extol the virtues of the VA, holding it as ...

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Who watches the watchers?  It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well.  It means, "How do I know that the people guarding me are worthy?"  It has also been translated, "Who guards the guards?" But it seems to me that it applies to medicine quite appropriately.  Who watches those watching physicians?  We ...

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As a long distance runner on my high school track team, I won few accolades in individual events, but shone in relays. My teammates and I spent hours perfecting our baton exchanges, which must occur within a limited area of the track, until these handoffs felt smooth and effortless. In contrast, world class athletes focused on individual performances are often assigned to relay teams at the last minute, a practice ...

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“Are you more or less cynical than when you started residency?” This was the question my program director asked our senior internal medicine residents at a recent dinner with Dr. Bob Wachter. If you aren’t familiar with Dr. Wachter, he is widely acclaimed as the “father of hospital medicine” and a renowned champion of patient safety and quality. His blog, Wachter’s World, is chock full of insightful commentary on the American ...

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You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains. You weren't supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs. Two days before you left us, I traveled home to visit you. I'd ...

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It’s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction, burnout and even suicide. In fact, some believe that up to a third of the US physician work force is planning to leave the profession in the next 3 years -- an alarming statistic. Direct primary care practices are touted as the best way to restore patient and provider ...

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Let’s face it. A hospital is a place where nobody wants to be. By it’s very nature, it is somewhere scary and not too nice. Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing -- enjoying a leisurely afternoon with the ...

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I was working overnight in Tiny Memorial Hospital, located in scenic rural America.  My call room there was a converted patient room.  As such, my bed was a hospital bed.  Lying there one night, I rolled to the side and raised the head of the bed using the button on the rail.  The blanket was standard hospital fare: stiff and thin.  And the television remote, fully two pounds and connected ...

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A well-to-do patient recently boasted to me about an expensive insurance plan that he had purchased to “guarantee” that he had access to the best health care in the United States. Coverage included access to elite academic centers (all the usual suspects) and a private jet service for emergencies. He was utterly confident that his investment was worth the price, but I withheld my own misgivings. Hospital quality data suggest that ...

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Why doesnt everyone have a pocket ultrasound machine? For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, ...

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