Question: My family (including two small children) and I are relocating this summer for my husband’s new job after seven years of living in the same area for residency and fellowship to a city where I know no one. I am scared about leaving our support network of friends and family nearby. Can you offer advice on starting over in a new place? Answer: I would guess that almost every physician family has ...

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The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t. The U.S. lags behind other industrialized nations in many important health measures -- partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious -- but we’ll explore some ...

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An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort ...

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In late January, government officials announced a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services.  As Medicare goes, so go private insurers; this makes the agency’s move toward quality-based reimbursement nothing less than a sea change. It builds momentum for a view of health and health care that is integrated and holistic, rather than comprising discrete, disjointed episodes of treatment. This ...

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Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t. He spoke rapidly with a slight ...

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American physicians have had it.  We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers.  The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore.  “You have it better than most people.”  “You are still making good money.”  “Your patients still need you.”  “It will get better.” “You ...

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In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 -- a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month. This is such a familiar story by now that it hardly makes news. Yet it is tragic, every single time, when ...

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medpagetodayFrom MedPage Today:

  1. Folate Supplements Cut Strokes in Hypertension. Folic acid supplements significantly decreased risk of first stroke in those with hypertension.
  2. Patients Will Record Encounters, and Docs Must Adjust. Physicians must accept the possibility that every conversation with a patient may be secretly recorded by the patient.
  3. Legalities of ...

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(with a hat tip to “Who’s On First?”) acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. (Scene is the back office of a small primary care clinic. Lou is sitting at his workstation, looking at a computer screen. Bud walks by and Lou stops him …) LOU: Hey, Abbott! I just saw a lady ...

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The world of health care will likely look very different in a decade, owing to a variety of diverse factors including; medical breakthroughs, political reform and not least of all the tremendous advances in technology that are occurring at breathtaking pace. The traditional model of the doctor-patient interaction will also continue to change dramatically (as it already has over the last several years). The days of an unchecked paternalistic relationship ...

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