This month, the literature and medicine group at my hospital met to discuss Arthur Miller's Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with "a shoeshine and a ...

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Should doctors grab a .health domain?So, you're setting up a website for your practice. You thought you'd just grab a .com, .net, or maybe .info. But now there's .health. Will one of those set you apart from the .com crowd? So what do you need to know about these new domains? 1. Will patients come looking for me on .health? The bottom line is that it's highly unlikely patients ...

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As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality? In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually ...

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People die without love: Why I prescribe the love drug As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love. During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the corner ...

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My friend breathed a sigh of relief as she finished her last clinic visit for the day and headed down the hall to the physician workroom.  It was only 5pm.  She still had notes to write and labs to check, and as a senior resident she needed to make it back to the hospital wards to check on her team’s interns, to get updates on the afternoon’s events and help ...

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I was reading a medical home advocacy group’s upbeat approach to a recent JAMA study that had found scant benefit in the concept when, suddenly, we tumbled into Alice in Wonderland territory. The press release from the leadership of the Patient-Centered Primary Care Collaborative (PCPCC) started out reasonably enough. The three-year study of medical practices had concluded that the patient-centered medical home (PCMH) contributed little to better quality of care, lower cost ...

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Recently, a patient I have known for several years called my office and spoke to my nurse. She said that while she was driving, her vision had gone blank for one second and then she was fine. My schedule was already overbooked. Almost all of the slots were filled with patients with the usual array of multiple chronic medical problems for follow-up and management of what were, for the most ...

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Deductibles and donuts change the flavor of health careA guest column by the American College of Physicians, exclusive to KevinMD.com. In the annual cycle of a medical practice, there are seasons. For example, we have "flu season," "poison ivy season," "camp or school physical season," “snowbirds back from Florida season,” and in my part of the world, "Lyme disease season." There are other seasons that physicians must endure that have ...

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More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field. First, ...

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Sorry for the long gap between blog posts. I have been distracted by the volume of work that I have had to do.  Is that a good thing? Yes. Is it a bad thing?  Certainly. I recently heard an interview of Mark Cuban, the owner of the Dallas Mavericks basketball team, billionaire entrepreneur, and one of the "sharks" on the show "Shark Tank." The show involves entrepreneurs the opportunity to pitch ...

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