Improving health care: Are physicians knights or pawns? How do we motivate physicians and other health professionals to work at their best? How do we create systems of high performance? Is it by a series of top-down highly specific mandates or by setting up general guidelines and providing tools? I believe it comes down to one’s vision of physicians. Are physicians knights to be empowered in their service of patients ...

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Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like ...

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I wouldn’t say I’ve had a lot of revelations in my professional life, but there is one that still affects me emotionally to this day, and it’s about nurses. I had been a PICU doctor for a number of years, and I was rounding on all the patients in the PICU with the rest of the team. The background sounds consisted of the usual beeps, alarms, and humming from the patient’s ...

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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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