Long ago, before our hospital changed over to a nearly complete hospitalist model, the faculty at our internal medicine practice served as the attending of record for all of our own patients, as well as the patients of the residents we supervised, when those patients were admitted to the inpatient services across the street. When we would arrive in the morning, we would look at the admission list, note that one ...

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I swear by Epic, by eClinicalWorks, by Allscripts, by AthenaHealth, and by all the coders and accountants, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my mouse in this art equal to my own hand; to make it right-click as well as left-click; when my ACO is in need of money to share an “at-risk” portion of ...

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So, how do you do it all? It’s a Monday morning.  After a flurry of activities, I am walking into the office at 8:00 a.m.  I think back to the past 2  to 3 hours.  I was up at 5:30 a.m., and in my workout clothes soon after.  I managed to squeeze in a 20-minute workout, thanks to a video on YouTube.  I then reviewed my schedule and patient charts for ...

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"Too many times I feel We are losing time once shared And only when you're in ecstasy You seem to really care" I recognize the song immediately — Chuckii Booker's "Turned Away." Not the regular version, but the extended one. As the words rush over me, caressing my nostalgia, a memory, a moment comes back. I was standing behind the counter at Homer's Ice Cream on a brilliant summer morning before the doors opened. We ...

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How do you describe the feeling when you are at a restaurant, and the waiter sees your coffee cup at less than half full (never half empty) and without asking they refill the cup or better yet, bring you a fresh cup of coffee?  If you are like most customers, you have a nice feeling about the restaurant and the waiter as they have anticipated your needs.  Usually, this anticipatory ...

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Recently, one of the biggest mistakes ever observed on live television occurred when Warren Beatty and Faye Dunaway, presenters of the award, announced the wrong film as winner of the Academy Award for best picture.  Not since Janet Jackson's costume malfunction has, live television caused such uproar. How could this have happened?  How could it have been prevented?  Moreover, what can this error teach us about how we care for patients? A ...

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Here’s a quote that readers will not readily recognize: "It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks." I’ll share the origin of the quote at the post’s conclusion. How’s that for a teaser? I'll give you a hint below. Physicians, by training and experience, are guarded with our words. To begin, we are never entirely sure of anything, ...

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The surgeon told me: "No offense, but girls really aren’t cut out for this work. They’re too fragile. They get too emotional. It’s not your fault; it’s biological." Yes -- health care is sexist. And it is racist. And just like our country, it is divided. Brilliant people face an uphill battle against prejudice as they work to become healers. Abuse within the system is rarely punished or even noticed. This has to ...

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Too often, the practice of medicine in the United States is focused on treatment. Doctors are taught to battle disease and treat chronic illness to the bitter end. And we have amazing technologies and treatments that have been proven to save lives, but our costs and health outcomes don’t seem to match what we pour into the system. But what if we doctors changed how we think about battling disease? What ...

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Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data.  And the picture does not look good.  Paying doctors to improve their quality metrics does not, in general, improve those quality metrics.  Like all good scientists, we can now either question the data, or discard the hypothesis. Most payors and administrators appear to be reacting to the lack of efficacy data on ...

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