Recently, physicians in small private practices and rural areas breathed a collective sigh of relief.  There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed.  Thank you, Mr. Slavitt, for listening.  I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind.  We have a window of opportunity for rural health care to survive, but we ...

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burnout2 Illustration by Jorge Muniz, PA-C. We enter medicine with our hearts and souls on fire ready to serve humanity. By the time we complete medical training many of us have anxiety, PTSD, depression -- even suicidal thoughts. Why? Medicine is stressful. Many of us work 100-hour weeks surrounded by suffering and death. We may deliver a stillborn, try to save a teenager with a ...

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I recently wrote an email to two Muslim colleagues apologizing for our nation’s political tenor. I shared with them my embarrassment over suggestions that our government bar Muslims from immigrating and monitor those who live here, my concern that a presidential candidate’s support congeals rather than erodes when he brays that “Islam hates us” and suggests that mosques be closed, and my dismay that so few ...

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“The road to success isn’t productivity, it’s differentiation.” – Tony Crabbe That statement is invaluably true -- especially for direct primary care (DPC) professionals. Your patients aren’t coming to you because you’re the same as everybody else. In fact, they’ve chosen you for the exact opposite reason. You’re gloriously different. The other guys force patients into the mold they’ve created: restrained by long waits, life-sucking insurance battles, and reduction to nothing more than a chart to be ...

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They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my ...

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The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world -- and there’s no room for certain people who appear to hold us back. Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, and ...

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You’ve all heard it. Those ads about that wonderful product that will change your life. The new kind of mattress that will finally give you a good night’s sleep every night. The new electric car. The superfood. They go on about them for thirty seconds or a minute, you are enthralled, and you dream of going right out and purchasing. Ah, marketing, how powerful you are. How much we want ...

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The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.”  History taking is not science, but rather, art, because it requires interpretation and clarification.  Patients with the same symptoms express them differently.  A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon. A few examples might clarify these concepts. The patient tells you that they have chest ...

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I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians. I was making decent money at my practices in Seattle and Tucson. By all accounts, I was ...

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Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College. We challenge CMS to completely ...

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