Recently in the New York Times, Dr. Ezekiel Emanuel suggested that this year's resolution might be to abandon the ritual of your annual physical. The title of his column, perhaps chosen by an editor to maximize glibness and thus provocation was: "Skip Your Annual Physical." But permit me to suggest you don't commit to that just yet. The annual physical exam warrants some more examination, a defense to follow its prosecution. Dr. ...

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One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time.  But you know what? I hate being late myself even more.  In fact, I cringe at the thought. Conscientious, successful people are on time. Always. So you can imagine that nothing irks me more than being late myself. But I am late -- 10 minutes, ...

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I do not think that word means what you think it means.  - Inigo Montoya, The Princess Bride Stick to Facts, sir! … In this life, we want nothing but Facts, sir: nothing but Facts! - Charles Dickens, Hard Times “Information without context isn’t transparency” flashed across my Twitter feed. So now I am thinking about context, and communicating context, in medical care. This quote, from Heather Pierce, JD, MPH, Director of Science Policy and Regulatory ...

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7-steps-to-get-what-you-need-from-your-doctor-640x423 Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures? Follow these seven simple steps to get your doctor to do what you want. 1. Get organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss -- and your ideal outcomes for each. Patients who are ...

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The nationwide shortage of physicians is a very real crisis across all 50 states, causing a huge strain at all levels of health care. Hospitals and clinics are struggling to hire, current physicians are overworked, and ultimately patients have to wait longer. There are a number of reasons why this has happened, but one thing’s for sure: With the aging population, the problem is only going to get worse. One estimate from ...

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Medicaid A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e., on average, she makes less than minimum wage when treating a patient on Medicaid). The enthusiasm for expanding Medicaid coverage to the previously uninsured ...

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My mother is a very smart woman.  I see it in the way she solves problems, creates complex crafts, and navigates hard conversations. She can't, however, add fractions. She was never very good at math, she says. "I was never very good at math" is a dirty phrase that garners much attention in my household.  My husband, a sixth-grade math intervention teacher, spends just over 170 days each year attempting to ...

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Yikes:

The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.
Holy crap: They’re really doing it. Or trying to do it. Who the hell knows what they’re trying to do? Not “them,” that’s for sure. The United States government via the Department of Health and Human Services is going to start trying ...

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As physician burnout becomes more widespread, it’s time to think about the future. Do you have people asking you if you would be a doctor again? Not a week goes by without me being asked by either a medical student or a practicing physician: Do you recommend medicine to others? Or is physician burnout too rampant, too overwhelming, too all-consuming? That’s one of those super loaded questions. And it doesn’t have an easy answer. Here’s ...

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All physicians know the scenario. You want to reassure the patient; the patient wants another (usually expensive) test. In our new metric age, we may have a conflict between overuse and patient satisfaction. The article provides some hospitalist data: "Hospitalists know guidelines but overuse tests to reassure selves, patients." How do we balance making our best evidence-based decisions with patient demands? Some experts will tell us that we really have a ...

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