Projecting future physician workforce needs is a challenging calculation that must take multiple variables into account to avoid missing its mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large "physician surplus" and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program. Two decades later, there is a widespread consensus that the U.S. is ...

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Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing ...

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Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, ...

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We believe integrated will triumph fragmented every time. -Steve Jobs Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor. The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns ...

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Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients.  As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor.  Despite her instructor’s recommendation to ask ...

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As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved? On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. ...

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Look for a doctor who understands healingLook for a doctor who understands healing

An excerpt from In Sickness as in Health: Helping Couples Cope with the Complexities of Illness.

You are not a statistic Ironically, the surgeon who repaired her heart also left her heartbroken. While he and the neurologists may have considered it their obligation to present what they envisioned as ...

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Picture this. You walk into your doctor’s office for an urgent visit for new distressing symptoms.  He (or she) takes your blood pressure, temperature, heart rate.  All within normal limits.  He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two.  You ask him what he thinks is going on. The quandary If it’s a slam dunk diagnosis, the branch point in ...

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I recently spoke to a quality measures development organization and it got me thinking -- what makes a good doctor, and how do we measure it? In thinking about this, I reflected on how far we have come on quality measurement.  A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or ...

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Malcolm Gladwell thinks we should tell people whats it's really like to be a doctor.  And by God I have invested the last seven years in doing just that.  I have written countless blogs, given lectures, and traveled to Ireland.  I have coined the term Caring 2.0 to describe the bidirectional flow of empathy.  Patients will tell us what it is like to suffer with disease, and we ...

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