I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant. The telephone rang with the caller ID identifying a call on my office work line. “Hello this is the emergency department, please hold on for Dr. S.” ...

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Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits. Unfortunately, too many Americans lack easy access to primary care.  Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. ...

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There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald's that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances.  Or at least that is how the proponents of algorithmic medicine see it. In addition, electronic health record systems create uniformity by enforcing ...

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Faxes! Who still uses faxes? The medical industry does. Here is a picture from just today: 27 faxes received and about 20 sent, and that is only counting after noon. Some days are worse, with up to 40 faxes to handle in our small medical practice. Who still uses faxes? The medical industry does. On the left are the 27 faxes received: We use e-faxing, so they arrive as pdfs. On ...

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Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform. After almost a decade of practice, the fact is that I like my job. Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when ...

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As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it. In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist ...

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Part of a series. Comprehensive primary care for employees means better employee health, greater productivity, less presenteesism and lower costs for both employee and employer. That is why some companies are making health care a strategic imperative rather than just a tactic as part of human resource cost management. Some are developing full service enhanced primary care clinics on site with excellent success as described in my last ...

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Britain’s most prolific serial killer was a general practitioner (GP), Dr. Harold Shipman. He wasn’t England’s most famous murderer. That accolade goes to Jack the Ripper. The Ripper killed five women in the streets of Whitechapel. Shipman might have been responsible for over 200 deaths. Shipman’s legacy to the medical profession was not just a permanent simmering of mistrust. He triggered the introduction of revalidation, Britain’s version of maintenance of certification ...

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My life changed dramatically when I started my new practice.  The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new.  That's a tough thing to do with four kids, three of whom were in college last fall.  OK, that's a stupid thing to do, but my stupidity has already been well-established. Yet even if the income stayed ...

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When I was in high school, a national hardware retailer opened a new franchise down the street from the mom-and-pop hardware store that had served my neighborhood for many years. Since the new store had the advantage of larger volumes and lower costs, it seemed to be only a matter of time before it drove its smaller competitor out of business, the way that big bookstore chains and fast-food restaurants ...

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