As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals. In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have had family slang or nicknames for certain areas of ...

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Two patient result letters: Which one did this physician send? Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada. Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. ...

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“There was one time when I wasn’t here for seven months in a row,” ”Pam” told me. I sat with Pam in her third floor hospital room -- the floor on which she always stays when admitted to the inpatient medicine service -- as nurses, doctors, and janitors poked their heads in the door to say friendly hellos and “Nice to see you again, Pam!” A dining facility staff member entered ...

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CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient ...

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Regulations are changing the very heart of medicine You treat a disease: you win, you lose. You treat a person, I guarantee you win - no matter the outcome. - Patch Adams Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. ...

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If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team. I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own. Admittedly, it’s not quite the surgeon general who ...

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Consider the lipstick sign in your next physical exam The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning. Fine motor skills and concentration can be correlated with a positive ...

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Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients.   Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice.  I agreed to the terms and conditions of any large ...

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A sleeping dragon awakes. At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO. The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and ...

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Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust ...

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