Our health care system makes no sense. But what if it did? The conversation was almost comical, until I thought more deeply about it later.  Apparently I was on "the list."  Insurers make such lists for customers who are  searching for a doctor who accepts their coverage.  Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a ...

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Once upon a time, in a medical school far far away, I was taught that my sacred oath was to the patient.  The one patient; not the patient down the hall, in the next town, or in a country halfway around the world.  I would commit my heart, soul, sweat and blood to the suffering and healing of the person directly, immediately in my care.  This was a noble calling ...

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As the PBS Newshour recently reported, Westminster, Massachusetts could be the first town in the United States to ban the sale of tobacco. As I watched the debate unfold among neighbors, I was shocked at the level of intensity with which citizens stepped up to defend the sale of tobacco in their town. At one point an elderly gentleman dependent on nasal oxygen due to years of smoking-related pulmonary disease states ...

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3 guaranteed ways to improve patient satisfaction With roughly 1 billion in Medicare reimbursement dollars being tied to patient satisfaction, it’s no wonder the focus on patient experience is swelling. Of course there are other factors fueling the focus -- the proliferation of online physician ratings websites, ACOs, and CG-CAHPS to name a few. Over the past decade I have visited 100+ different inpatient and outpatient ...

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Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients.  We’ve all seen -- many times -- the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance.  Making the correct diagnosis is only the first step in helping a ...

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Ferguson: What should physicians do? There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest 
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Get help: Most physicians are not good at business We’ve all heard or used the phrase, "Leave it to the professionals." It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car ...

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A walk in Central Park: Contemplating physician burnout There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help. That immediate ...

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A few months ago I assessed a patient with dementia.  I dutifully ordered the appropriate blood testing and MRI.  As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment.  The best way to differentiate these two syndromes is neuropsychological testing.  I decided to send my patient to a colleague ...

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After residency: I’m scared to practice outpatient medicine As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this? Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient ...

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