Part of a series. In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case ...

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I don't like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician.  I like to play Sherlock Holmes and figure out what's going on with people, and I think I'm pretty good at it. So I lied.  I do like to brag ... a little. In most people's mind's eye, the role of diagnostician ...

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It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process.  In addition, patient engagement and co-management of their disease has been proven to improve outcomes.  A new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance; when a pill looks differently patients often simply ...

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We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. - Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst. The expression, “the devil is in the details” implies that the details can ...

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During her annual physical exam, one of my patients recently asked me, "Are urgent care centers any good, Dr. P?" She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care -- at least some medical attention -- more imminently than she could get from waiting to speak to my office in the morning. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia. On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI ...

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Consider the messages that tattoos are sending Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle scarred chests. Occasionally, ...

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Are American doctors paid too much or too little? A version of column was published in USA Today on July 2, 2014. There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs.  I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, ...

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Have you ever had a situation where your perception of some event or entity changed dramatically in an instant? I specifically remember an instance of this happening to me while working as a junior medical student in a family practice clinic. It was a typical day and I was doing the typical thing that you’re supposed to do as a medical student -- feign interest in the clinic’s goings on and try ...

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This is a simple plan that would empower patients, improve the lot of primary care physicians and likely hold down medical costs while improving quality in the health care system. I would first like to present the plan, then elaborate on how it could accomplish the above objectives. The first part of the plan would set aside a portion of each person’s health care dollars (i.e., insurance premiums) and place it ...

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