We have a problem in our clinic. Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled. There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders. Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty. That ...

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As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world.  I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or ...

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"I love you," she said as I was leaving the room. Although I was stunned for a second or two, I wasn't really surprised.  She and I had gotten along famously from the beginning of our 15 minutes together.  She didn't "love me" in the way a patient with borderline personality disorder "loves" her enabling prescriber.  She loved me because I was there, I was experienced, I was kind, and I ...

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I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help.  I have deep respect for the challenge of medicine and the committed practitioners. When I left graduate school in 1988, it was the beginning of the movement from fee ...

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What is your dream job? It’s the one you would do every day even if no one paid you. When you find it, you never really go to work each day, you go and play. If that is the kind of joy received from working, then burnout will likely be a long way out of reach. Are there any jobs like that out there for doctors? Yes, there are. But ...

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Like many physicians, I’m a people pleaser.  On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering -- and I really meant it.  What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically. Medical school and residency didn’t adequately prepare me for the emotional strain of ...

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As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training. Most people ...

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Taxes. Doing taxes feels like a financial rectal exam.  I hate doing taxes.  Yeah, I don't like getting rectal exams either. It's not that I resent paying the government for the fine services they render and the high quality of elected officials we have. It's not the existence of taxes I hate; it's just doing taxes make me feel extremely insecure.  Sharing my personal and business finances with my accountant and the ...

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Physicians play many roles in patients’ health care and lives in general. In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision. In the very next appointment, we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes. We sometimes find ourselves in ...

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The behavioral aspects of poor health are even more important than we may have thought.  That’s according to a new study finding adults who engage in even one unhealthy behavior double their risk for fair-to-poor health. And the risk increases meaningfully with each added unhealthy behavior. Spotlight: Impact of Unhealthy Behaviors, a publication from United Health Foundation’s America’s Health Rankings® released in partnership with Family Medicine for America’s Health, ...

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