Living in the fine city of Boston, I am fortunate enough to be located right in the middle of a medical hub. A place that’s full of exciting new research, developments, and ideas. Working at the front line of hospital care, also with a keen interest in quality improvement, patient experience, and technology, I frequently attend social and professional healthcare networking events around the city. While doing this, I’ve gotten to ...

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A.J. Smith, a pseudonym of course, walked into my office today, unhappily.  Most of her topical medications for acne caused too much irritation.  The ones that didn’t, weren’t working.  The doxycycline caused photosensitivity in the past.  But her friend’s dermatologist gave her isotretinoin, better known as Accutane, and she completely cleared.  As such, that’s what my patient demanded.  There was only one problem.  The degree of her acne didn’t warrant ...

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The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians. WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary.  This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation. Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, ...

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Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable.  Did you notice a particular word missing?  Yes, I missed the word physician too, because they have been left out of the conversation entirely. Measuring quality health care by ...

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“Hello? Hello, Mr. Bertsie. It’s Dr. Robey. I wanted to call you and check on you,” I said into the phone stopping my constant wrestling with papers and resting what was in my hands on my lap. Mr. Bertsie and I were meeting in the equinox. “Oh, hello Doctor,” he said with a little relief, a little surprise, a little delight in his voice. “I’m doing OK. I walked the dog ...

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In July, I found myself needing to step away from social media and news coverage of the recent shootings in Louisiana, Minnesota, and Dallas. Being a psychiatrist has made me sensitive to the toll of pain and anguish that life may bring, even as a bystander. This occurs even more so when I can all too easily imagine myself as a victim of one of these unfortunate events. In the aftermath ...

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I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer. A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis. Unfortunately, his condition deteriorated quickly thereafter, ...

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I was in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email on my phone. I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week. I had to laugh out loud. The rest ...

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"I'm going to the doctor next week for my yearly physical." So normal. Of course you are. Everyone should do that. But the concept of a yearly examination of one's whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question. I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at ...

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Let me preface this blog by stating that I write this to stimulate discussion and debate, not to sway opinions. Today, doctors are required to spend more and more time doing administrative work -- including checking off electronic boxes in the electronic medical record (EMR) -- the result is less quality time with patients. Now, those that are in Washington, DC think that requiring physicians to ask about guns in the home ...

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