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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The state stopped by to see us the other day. Wow, that sounds ominous. No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program. A few ...

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Hard truths: Dispelling 10 health care myths 1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth. But the truth is that the vast majority of physicians are average in virtually every way. Despite all claims to the contrary, ...

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Between paternalism and servility: A balance physicians must straddle Even today there are patients who leave diagnosis and treatment entirely to their doctors.  They make no effort to inform themselves about their illness or chart their own course; they do whatever their doctors advise.  Once the norm, this passive, willfully naive attitude has withered in the face of a multigenerational attitude shift, coupled with the wealth of medical information at hand today. Direct-to-consumer drug ads on television, online peer support, medical websites ...

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Value based care: Bad for doctors, bad for patients? Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum ...

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Doctors talk with their patients about many things that might make some people uncomfortable -- sexual issues, abuse (physical or emotional), anxiety, depression, sleep habits, bowel habits, and fears about health-related topics -- things that many people might not talk about in casual conversation at the coffee shop or at work. Doctors talk with their patients about smoking, weight, eating habits, exercise, seat belt use, helmet use, and a myriad ...

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You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan. I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the ...

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Even in the 21st century, talking to your doctor about your symptoms matters. This is something I tell my medical students. Talk to your patients. Listen to your patients. Use their story to determine what tests and imaging tests to order, if needed. Don’t get fooled by technology or be in awe of its importance. It is the patient’s experience that matters.  It isn’t the other way around as we ...

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A frustrating patient, and how that affects her physician There’s a patient I don’t like very much. I’ll call her Mrs. X. Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur. Every time she makes an appointment, ...

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Even if you don’t live in a city yet that offers Uber’s rideshare app, you probably have heard about it, because the media has widely reported on job actions by taxi cab drivers -- and the gridlocked traffic that resulted -- that has taken place in Washington, DC and in other major cities across the world including London, Berlin, Paris and Madrid. Uber is an “on demand” smart phone app that allows users ...

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