As I entered the exam room to meet my new patient, I initially thought of the orange-haired heroine in the animated kid movie, Brave. Although the middle-aged woman's hair was not quite as orange as the heroine's, it was long, expansive in breadth and wavy in texture. Her hair seemed to engulf her petite frame. As I looked at her more closely, she appeared rather slim. Her layering of clothing ...

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Vox's Julia Belluz wrote a nice article explaining why doctors overprescribe antibiotics.  She essentially gives two reasons: doctors unsure of the diagnosis want to be "safe," and patient demand. But there's a third reason that's an extension of demand: patient satisfaction. More patients have to take time off work to see their clinician, only to spend a few minutes in the exam room.  Those who take that inconvenience likely won't want a lecture on ...

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Part of a series. Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart. Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or ...

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Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin. Last year was a ...

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It hit me today while on hold with an insurance company to get a preauthorization. The call took thirty minutes. The medication was denied. And I knew that I was going to get an earful from the patient when I delivered the bad news. As I dialed the phone number, a disturbing, and yet all to familiar, feeling overtook me. Helplessness, powerlessness, impotence. I struggle with these feelings daily. In the beginning ...

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As we enter into the Thanksgiving season, the question of what we are thankful for is frequently asked . Perhaps it is a good reminder for us to take a step back and express gratitude for events that or people who have made a true impact on our lives. I think that for us as medical professionals, it is all the more important, since conditions in the hospital may make ...

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Whenever you read a health care article, paper, book, blog post or even tweet, that substitutes the term consumers for patients, and the term providers for doctors, or physicians, you should inherently assume that the authors are advocating for something that will not benefit you or the people you care for, something that will most likely harm you financially and if you happen to be less than independently wealthy it ...

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In his post, "The geriatrician shortage: The problem isn’t what you think," I completely agree that the current gap in health care professionals’ skills to care well for our aging population is exceedingly complex, reaching well beyond lack of medical school training or funding.  Funding for graduate medical education needs to be transformed to match the workforce needs of the nation, with special attention to filling workforce ...

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I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or ...

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She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable ...

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