Do you want a culturally competent practice? Here are 15 tips. Over the last few years I started a family practice serving refugees, and have seen 10,000 refugee patient visits. With regards to culturally competent medicine, medical schools teach about traditional remedies such as coining, and maybe role play with interpreters, but stop short of practice design ideas. The AAFP provides a checklist of qualities, which I feel could ...

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It used to be that the greatest cost at a doctor’s visit was paying for the visit itself. Nowadays, the office visit is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help with the un-Affordable Care Act. In the last few ...

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Many of our patients are besieged with unsolicited Internet advertisements offering them unbelievable solutions and cures to most of mankind’s medical maladies.  Patients come to and ask for advice about these promises to magically restore their health. Since I receive so many requests from patients to evaluate these offerings, I have put together five questions that patients should ask themselves before proceeding to buy from websites offering outlandish claims, including restoring ...

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“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.” I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with ...

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She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches ...

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Team-based care is one of today’s buzzwords without real substance, because unless the payment systems change, only the physician members of the team can bill for their work. Few people seem to be concerned with the simple but essential question of how physicians spend their time and how medical offices are paid. As a primary care physician who doesn't do any major procedures, and who in 2014 is essentially paid fee ...

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On September 28, 1864, the first meeting of the International Workingmen’s Association (IWA) was convened at St. Martin’s Hall, London.  Among the attendees was a relatively obscure German journalist by the name of Karl Marx.  Though Marx did not speak during the meeting, he soon began playing a crucial role in the life of the organization, in part because he was assigned the task of drafting its founding documents. The work ...

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Motivate patients to exercise more and eat less “Plank? Is that a board?” asked my patient. I had been encouraging her to start doing exercises to strengthen her core in order to stabilize and support her back. My hope was that over time, these exercises would lessen the need for pain medicine. There are times for words and there are times for action. So I got down on the ...

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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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