“Robert Loeb was the best damned ethicist I ever met.” When I first heard a senior colleague of mine utter these words in the mid-1990s, I was surprised.  Time had not been particularly kind to Loeb, who had been the chairman of medicine at Columbia-Presbyterian Medical Center from 1947 to 1960.  Among other things, critics had chastised Loeb for being imperious and unwilling to listen; former students had even accused him ...

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As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history.  I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous physician ...

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Over the years, my husband’s parents, Helen and Dave, have both suffered unnecessarily from bad medical care. They are not alone. A botched cataract surgery left Helen with a torn iris. One of her eyes can’t adjust to light, and for the last several years she’s worn sunglasses indoors. Her urologist kept treating her with the same antibiotic for urinary tract infections without testing to see what bacteria she had. When ...

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I recently described the loathsome “relative value unit” (RVU) and its role in the decline in prestige and pay in primary care.  The RVU is maintained and updated by a small panel of 31 physicians called the Specialty Society Relative Value Scale Update Committee (RUC).  Twenty-seven of the 31 physicians are specialists, which is not at all representative of the physician workforce, given that primary care doctors comprise over one third of ...

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When I first met Ralph, he was 82-years-old.  He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer.  Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery.  Ralph made it; his wife died.  Today, twelve years later, he brings me treasures from his metal detecting hobby on the ...

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My 87-year-old father broke his hip this past weekend.  He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair.  The good news is that he’s otherwise pretty healthy, so he should do fine. Still, getting old sucks. During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: Technology can really make things much easier:

If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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It is time for American physicians to rise up It's time for the American physician to stand up. We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for another guideline post, this time at the American Academy of Family Physicians. Recently I joined the AAFP's Commission on Health of the Public and Science, which formulates guidance for family physicians on a variety of topics, including clinical preventive services. My appointment coincided ...

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