Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the ...

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“What do you want for dinner?” I asked my wife. “I don’t know,” she answered.  “What do you want?” “How about hamburgers?” “No, I don’t want hamburgers.” “What do you want then?” “I don’t know … pasta.” “I’m a little sick of pasta,” I said.  “How about pizza?” “I’m really in the mood for pasta.” Silence.  Then:   “OK, pasta.” I’ve observed, both among my patients and my friends, that the issues which ultimately threaten to dismantle romantic ...

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One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn't shocking. The patient hadn't been doing well lately, and I wasn't surprised when I got the message that they were on the way to the emergency room. Due to our ...

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On a 12-hour shift in the hospital, I recently spent a mere hour with patients, with the rest glued to a computer screen, to the "iPatient." When a patient comes to the hospital, speaking to them has become an afterthought to reading extensive medical records, physical exam findings from the emergency room, and synthesizing laboratory data. I, as a millennial doctor, have been on the cusp of this shift. My ...

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Our current health care system will fail; it’s simply a matter of time.  Yet the delivery of efficient, quality, and progressive health care is quite possible once we shift our thinking.   A true paradigm shift in medicine begins with first establishing that each pillar in health care has an equal responsibility in making a new system work:  patients, providers, and places (facilities). This article pertains to only the provider portion. As ...

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Is it medically professional for a non-profit organization to use physician testing fees to "choose wisely" a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption. After a review of public and tax records, it appears to me this is exactly what has happened. Background In 1999 for reasons that ...

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She is a time traveler. She spends an hour with each patient, takes note of each symptom, listens to each emotional concern, takes every call from every worried patient, handles all emergency situations, fills every prescription, handles each every insurance concern, breaks bad news gently, does her hospital rounds, yet is never late to see those in the waiting room. She treats her patients as unique individuals with unique human emotions ...

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“Good afternoon officer, is there something wrong?” I was a second-year medical resident on the way to my father’s birthday dinner.  It had been a very long week and I was dressed casually in a T-shirt, shorts, and sneakers.  Finally, I could kick back and be “normal” for a day. At least that’s what I had thought prior to being pulled over. I had previously experienced the occasional purse clutching woman, a few ...

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He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway. Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries. The day of ...

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As I sit home spending Christmas with my family this year, I look back on the past few years of my practicing medicine and realize how much of a luxury this is. While most jobs allow employees time off for particular holidays, health care is a profession where we are called on numerous occasions to sacrifice our time in order to care for others. Frequent are the calls we make ...

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