Doctors and patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine. Delivering bad news is, unfortunately, an unpleasant part of a physician’s job. Honesty, empathy, and clear communication are essential to delivering news to patients and their families -- even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, ...

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Life is tough for physicians in solo and small group practice.  The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases.  “Meaningful use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive.  And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data ...

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Years ago, as a young cardiologist in inner-city Brooklyn, I remember an elderly Spanish-speaking patient named Maria who faced the painful task of deciding whether to use her government subsidy to buy groceries or to fill the medications I had prescribed to treat her heart failure. I wasn’t unfamiliar with this kind of poverty. I had been born into a Jewish family in Tehran, and soon after, we fled Iran to ...

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Many physicians feel burnt-out from their careers A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has increased since the last survey in 2013, with 46 percent overall reporting these feelings. When looking at specific specialties, the most burnt-out physicians are critical care and emergency doctors. Half of primary ...

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Businessman and maverick, Mark Cuban recently opined, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘ He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge ...

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There’s nothing like discrimination -- true or imagined -- to keep our airwaves humming. Recently, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom. Yes, I know the other side of the argument, that these religious freedom protections were veiled attempts to discriminate against the LGBT community. Both states raced to revise their original laws, although the laws' backers deny any discriminatory intent ...

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A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way. The guy -- Steven Keating -- is not your average Joe. He is a ...

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How to Win Friends and Influence People by Dale Carnegie is a timeless bestseller. It is a book that’s translated into many languages globally and carries brand name recognition.  People who read the book recognize common sense approach and simple lessons of courtesy that are so eloquently described by the author. Dale Carnegie had a knack for oratory skill and displaying genuine connection with other human beings. While he tried many ...

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America faces a serious shortage of primary care doctors. The reasons are not hard to understand. Lower income is the most important factor.  Adult primary care doctors (general internal medicine physicians and family medicine physicians) earn on average $100,000 or so less per year than specialists do. Our income is much greater than that of the average American, and so many people have little sympathy here.  But almost all people prefer ...

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I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine. If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics: 1. Team leadership. Every doc is a leader to some degree, ...

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