The VA scandal over excessive waits for doctors’ appointments is an early warning of things to come. Over the last three years, the demand for primary care appointments at the VA increased by 50% while the number of providers rose by only 9%. With four hundred vacancies for primary care providers, the VA is facing a severe gap in its ability to care for its patients. It isn’t surprising that the ...

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Recently I went to a physician and left pondering the question: "What is health anyway?" This is an interesting question, especially one for a doctor to ask. But it's important because if we don't know what health is, how do we know if we've got it? If we don't know what health is, how do we know we've improved? As a doctor and medical writer, I'm finding it more and more difficult to write about ...

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Apple announced the company is working on a new app, called Health, that allows a user to store in one place all aspects of their health data, from heart rate to blood sugar levels, cholesterol measures and calories burned. The Health app, Apple says, will enable an exercise app to determine the number of calories you consume a day -- and, in turn, how hard you have to exercise ...

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I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive.  I have been criticized for this position, on the grounds that I am rationing care from people with ...

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Over the last few years I’ve had numerous encounters with vets and vet hospitals. Domino, the dog that we had since I was in medical school, was sadly very sick. He was a Jack Russell-Corgi cross, black and white, with the loveliest sweetest nature. He lived till almost 13-years-old, bringing an immense amount of joy to our whole family. Sadly, he passed away last summer. My parents felt a huge ...

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Is the practice of medicine more of an art or an applied science? It’s a debate patients may not even know is taking place. But the way your primary care physician, surgeon or hospital answers this question may determine whether you live or die. Doctors on the far “art” side of the spectrum maintain that every patient and physician is different. Therefore, they believe there is no one right way to treat ...

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In recent months, there has been a lot of talk on social media and in the press about how miserable many doctors are. These conversations have also brought inspiring alternatives to the forefront. For example, Zubin Damania, MD, founder of Turntable Health, and Pamela Wible, MD, a leader in the Ideal Practice movement, have notably and smartly encouraged doctors practicing on the front lines to take matters into ...

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Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression. Now, with studies to support their use ...

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For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was ...

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I have a confession to make.  The purpose of a recent blog post was to set up this one.  What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion. When I entered my first primary care practice in 2002, I had great doubts that the traditional ...

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