This is what population health looks like It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so ...

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5 health care megatrends to watch for Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip. At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to ...

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The new VA secretary, Robert A. McDonald, speaking to a room-full of reporters, acknowledged for the first time that the department needed to hire "tens of thousands of new doctors, new nurses, new clinicians." It is now accepted that a shortage of employees directly involved in treating patients was a main driver in the waiting-list scandal that rocked the agency this year. The second, and equally important driver, was the artificially created benchmarks, that ...

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“Am I a hypochondriac?” It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health. No, the fact that all you have is a simple upper respiratory infection -- the common cold -- instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and ...

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On the face of it, the phone call was relatively innocent.  A family member was confused about the test I scheduled.  Apparently the lab refused to draw the blood.  When I inquired why, I was informed that the patient hadn't been fasting.  I calmly explained to the daughter that fasting was not necessary.  Recent studies had shown little effect on lipid panel results and I was using the glycosylated hemoglobin ...

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Part of a series. Employers have seen their health care costs rise dramatically over the years. To compensate, they have expected employees to pay an increasing portion of the health care insurance premium, expected employees to pay significant co-pays with each physician visit and have purchased policies that restrict individuals to a narrow network of doctors and hospitals. Largely these have not worked. They have offset some of the expenditures but ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma. On ...

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One of the most important tricks of the trade that I learned in medical school was what some might have considered a little throwaway bit of advice. During my psychiatry clinical rotation the preceptor advised that, when applying the stethoscope to the patient’s back, one should rest the other hand gently on his or her shoulder. Human touch was important. It would relax the patient and convey subconsciously a sense of ...

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If a doctor doesn’t do excess testing, he isn’t going to be able to live An excerpt from Doctored: The Disillusionment of an American Physician. After the blowup with Rajiv, I committed myself to changing my standoffish ways. Rajiv had been urging me for some time to meet socially with his physician friends in a relaxed atmosphere away from the hospital, and so there I was a few weeks later at a doctors’ party in Manhasset, a tony ...

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When you feel yourself sinking deeper into a bad case of physician burnout, finding a way out can feel daunting, if not impossible. But it doesn’t have to. I believe recovering from burnout begins when you start taking small, purposeful steps in a new direction. I recommend you start by getting a handle on your work-life balance. Do you balance the time and energy you spend at work with the time and energy ...

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