Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order. It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t ...

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Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter. The second sheet, mysteriously, contains only a single line: This page intentionally left ...

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There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential. Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals ...

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I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your ...

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It's a cold and rainy morning, and we've traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region. There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a ...

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The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation. In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan. Yet our measurable health outcomes -- from infant mortality to life expectancy -- aren’t any better than nations spending much less. I’ve written about this paradox before, pointing to a few ...

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Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, "Are Children Overmedicated?" seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase prescribing of medication.  In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy ...

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From the moment some patients arrive in your office, nothing seems to suit them:

  • Your parking lot charges too much.
  • Your front desk staff has too many forms for them to complete.
  • Your waiting room magazines are too old.
  • The temperature in your exam room is too cold.
So why are some patients so grumpy? I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their ...

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It's one thing to ask a doctor to stay current on his knowledge, it's quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research. Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM's requirement for a practice improvement module worth a required 20 ...

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In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population. Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends ...

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