Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained. Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients. The idea of maintenance of ...

Read more...

Infrastructure is never quite as interesting or exciting as innovation. The grand opening of a new building incorporating all the latest integrated technology is far more exciting than bridge repairs. In our fascination for the innovation, we often turn a blind eye to our nation’s crumbling infrastructure.

In the United States today, one quarter of our bridges are structurally deficient or functionally obsolete and more than 100 ...

Read more...

Our family loves to hike. Traveling the trails is a deeply happy place for us. In fact, I don’t think there’s ever been a time when one of us suggested taking a hike, and everyone didn’t unanimously and enthusiastically agree. A few weeks ago, my family took a lovely hike in a state park in Massachusetts. It was a gorgeous day: temperature in the upper 40s, blue skies, no wind. The ...

Read more...

The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed. Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives. Then there are several cumbersome explanations about the appeal ...

Read more...

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear ...

Read more...

pamela wible Ever wonder what patients really want from doctors? Is it the fancy buildings with marble fountains? Is it the board certifications and diplomas on the wall? Is it the expert medical jargon and starched white coats? Nope. None of the above. Listen up, docs: Patients just want the real you. Ya know -- you. The competent and caring you who really listens with compassion. The real you ...

Read more...

Six years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP, who did a rapid strep test and prescribed me medication. I picked up my medication ...

Read more...

You don’t have a second chance to make a great first impression.

If twenty random numbers were read aloud, most people would remember the first few numbers and the last few numbers.  We tend to remember beginnings and endings.  It is the same with patients; they tend to recall what they hear at the beginning and the end.  This is how our brains are wired; ...

Read more...

Recently in the New York Times, Dr. Ezekiel Emanuel suggested that this year's resolution might be to abandon the ritual of your annual physical. The title of his column, perhaps chosen by an editor to maximize glibness and thus provocation was: "Skip Your Annual Physical." But permit me to suggest you don't commit to that just yet. The annual physical exam warrants some more examination, a defense to follow its prosecution. Dr. ...

Read more...

One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time.  But you know what? I hate being late myself even more.  In fact, I cringe at the thought. Conscientious, successful people are on time. Always. So you can imagine that nothing irks me more than being late myself. But I am late -- 10 minutes, ...

Read more...