The surgeon told me: "No offense, but girls really aren’t cut out for this work. They’re too fragile. They get too emotional. It’s not your fault; it’s biological." Yes -- health care is sexist. And it is racist. And just like our country, it is divided. Brilliant people face an uphill battle against prejudice as they work to become healers. Abuse within the system is rarely punished or even noticed. This has to ...

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Too often, the practice of medicine in the United States is focused on treatment. Doctors are taught to battle disease and treat chronic illness to the bitter end. And we have amazing technologies and treatments that have been proven to save lives, but our costs and health outcomes don’t seem to match what we pour into the system. But what if we doctors changed how we think about battling disease? What ...

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Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data.  And the picture does not look good.  Paying doctors to improve their quality metrics does not, in general, improve those quality metrics.  Like all good scientists, we can now either question the data, or discard the hypothesis. Most payors and administrators appear to be reacting to the lack of efficacy data on ...

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"I can do that?" During a recent morning practice session, a resident was presenting a patient who had had several episodes of syncope which culminated in a trip to the emergency room. She had a brief stay there, and on the discharge plan was written "follow-up with PCP and with cardiology."

We went through her history and physical examination, we talked about how to further ...

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Health care guidelines are produced in ever-increasing numbers. The National Guideline Clearinghouse, a U.S.-based public website compiling summaries of “clinical practice” (health care) guidelines, has over 1,000 entries and is updated weekly. The National Institute for Health and Care Excellence in the U.K. has over 180 clinical guidelines. The Conversation Health care guidelines cover all aspects of medicine, from using ...

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A recent publication in JAMA Internal Medicine clearly demonstrated that female physicians were able to provide better care when compared with their male counterparts. Researchers from Harvard University studied the relationship between physician sex and 30-day mortality and readmission rates of over 1.5 million Medicare patients between the year of 2011 and 2014. What they discovered was that female physicians had lower mortality and readmission rates ...

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In August of 1991, I became a family practitioner in the United States Air Force and was sent to Clark Air Force Base in the Philippines. During my time there, I was asked to go on a medical mission. This experience struck me with the missionary bug to provide my talents and to care for others in another country. With medications that were near expiration date in USAF stock and ...

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To my beloved patients and your families, Over the years, it has been an incredible experience and honor to be allowed to enter into your world. It is a world that I know few people are privy to, and it is an intimate world where the deepest questions about life tend to arise. I know that when you are confronted with sickness that leads you into this world, it can be ...

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The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, cholesterol levels, fasting glucose and urine protein. We discussed bowel and prostate cancer screening in detail, and I gave him written information as we were out of time. As I signed his script for the blood pressure medication, he winked. “That was easy money for you, wasn’t it?” Thirty-seven dollars and five cents is the value the government places ...

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I have only been able to make it back to my hometown once a year for many years now, but I recall my father having a very friendly dog many years back, a black Labrador mix named Abby. She was well behaved, would stay in the yard if you let her outside, didn’t cause problems, and was great with children. Then about ten years ago, another dog was added to the ...

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