The highest rated doctors may not provide the best care A version of column was published in USA Today on September 14, 2014. The public can rate and review most things today: books, hotels, and restaurants, to name a few.  Even doctors.  There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you're pretty much ...

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There is abundant evidence for malaise in the physician workforce, but little agreement about etiology, treatment options, or prognosis.  As a senior physician who still has a lot of involvement with physicians of all ages, I want to propose an etiologic framework. Perhaps if we agree on etiology, we can look at treatment options. There are three ways to look at what doctors do: the artisanal, the economic, and the scientific. The ...

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From a physician: A plea to big medical corporations I thought more highly of business folks until I started working for them.  I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc.  Once the vision was elucidated, everyone worked together like a team to make it happen. Then I became employed by ...

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We all want to practice evidence-based medicine.  Yet that phrase is so overused that one must always question the true meaning underlying the use of the phrase. The first assumption that many make is that evidence is a solid structure without nuance.  Yet we can have different experts look at the same evidence and develop different conclusions!  Why else would we have competing guidelines. Consider this quote from Nietzsche: "There are no facts, ...

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Burnout in medicine: Look beyond your comfort zone For those of you who have been riding along with me on my journey for the past few years , you know that it has been one heck of a ride. What started out as a little blog to encourage other doctors who were struggling with burnout has exploded. In a good way. My blog came about because I was looking for a ...

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I have been a victim of diagnostic overshadowing by a primary care physician.  I’ve been dealing with major depressive disorder, recurrent, severe and anorexia for twenty-five years -- practically my entire adult life.  However, I work full-time and I’m a published writer.  At the time I saw this PCP, I was on hefty doses of Cymbalta (an antidepressant) and Abilify (an antipsychotic which can also be used to boost the effects of an ...

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The days of using your insurance to see the family doctor are numbered. As more patients join the practice and I hear each new patient’s story, I become more impressed with the benefits of direct primary care for both the patient and the physician. Recently, a 63-year-old female, who we’ll call Martha, came in for a visit. Martha is an out of work chef who, due to financial hardship, hasn't had health ...

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Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists. From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s ...

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Years later, I now wonder if I overstepped my boundaries. Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a ...

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Just yesterday I was searching for a local surgeon, and on one website he had 2 out of 5 stars.  Hardly anyone was recommending him.  Yet prominently featured on another site he had 4.7 out of 5 stars.  Both sites had a good number of reviews.  What’s going on?  Is one site cherry picking the reviews?  Is someone falsifying reviews on one of the sites?  Which reviews can I trust? ...

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