shutterstock_77642626 Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts. The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year ...

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I am not an economist. This is how I start my high-value care session during the internal medicine clerkship orientation day at the Medical College of Wisconsin (MCW), and it is absolutely true.  It doesn’t take an economist, though, to realize that health care is too expensive.  Health care spending as a percentage of GDP has increased from around 7 percent in 1970 to almost 18 percent in 2010.   An ...

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“Nobody does this …” Dr. D said as a greeting as he walked in holding the 700-word letter I had sent him some weeks before my periodic physical examination. Half the letter addressed six issues that had arisen during the year and a half since my last physical. I thought, nearing age 62, that it’d be both efficient and prudent to provide my GP an update on my health experiences. Half ...

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As a patient, I would like a primary care visit that is pleasant, comprehensive, convenient, and efficient. As a future practitioner, I hope for a visit that is unhurried, educational, efficient, and holistic. We may have through all these years grown accustomed to the status quo -- on both ends -- that is, we have come to expect the 45-minute wait in the atrium prior to our beckoning by the ...

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The tragic deaths of Oscar Grant, Michael Brown, Eric Garner, Tamir Rice, Walter Scott, and untold others, deeply grieve our national conscience. But more black men die in America from heart disease than from police brutality, and we never mention those parallel realities in the same breath, let alone collectively mourn those dead. Why is that? Because it’s not just that African-Americans have higher rates of heart disease and its related risk ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. So far, 2015 has been a busy year for reflecting on the use of electronic health records (EHRs). CMS just released its proposed rules for meaningful use stage 3. One might say that “MU 3” supports the belief that the sequel is never as good ...

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Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much. For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every ...

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shutterstock_222269452 I assumed she asked because besides being a hospice volunteer,  I was a medical student and wouldn't get spooked by a dead body.  She probably didn't realize that it was my first week of classes, and I hadn't experienced much yet. She walked into the room with her head slightly bowed forward.  She was physically and emotionally exhausted.  Because of a scheduling ...

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shutterstock_231666442 I have been blogging now for about three years, posting once or twice a week and accumulating 240 posts.  I have my little flock of loyal readers and have managed to contribute a few drops in the ocean of the health care policy debate.  But just this month two pieces made some bigger waves, one ending up briefly fluttering about Twitter, ...

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Doctors and patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine. Delivering bad news is, unfortunately, an unpleasant part of a physician’s job. Honesty, empathy, and clear communication are essential to delivering news to patients and their families -- even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, ...

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