shutterstock_66058726 Recently, the Department of Health and Human Services (HHS) announced an ambitious goal to have 85 percent of payments made to doctors linked to clinical quality measures within the next two years. HHS believes that incentives should be weighted almost entirely toward quality of care instead of volume of care. I guess if you're a patient, you could ask yourself the ...

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Patient care is at a crossroads in a rapidly changing health care landscape. Going forward, will the majority of patients receive most of their care from a highly trained, well-supported primary care physician and team they know and trust? Or, in contrast, will patients receive care through a series of loosely connected episodes, from a wide array of narrowly focused providers? Who will adjudicate care for the whole person across ...

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My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen -- and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing something he loves, and his dream had always been to ...

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loyal patients Loyal patients are the lifeblood of a medical clinic. And devoted patients are worth their weight in gold. It’s a lot easier to care for an established patient that lots of one-timers who never return. Beyond ease of workflow, the economic benefits are fabulous. A loyal patient panel will stay with you (and pay you) through sickness and in health ...

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shutterstock_146645084 Physicians are docile.  We are programmed to put the greater good above our own.  We train mercilessly, work tirelessly, and bend faithfully at the alter of those we have vowed to heal.  This is our birthright.  This is the covenant we signed in our own blood when we took our healing oath.  Decry us as they will, no one becomes a ...

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When I entered the profession of being a family doctor, like many aspiring physicians, I had a more altruistic vision of what it would be like. However, the reality of that picture over the last 10-years has resulted in frustration, disappointment, and, above all, the realization that health care has changed for the worse. It has become unaffordable for the masses and institutionalized for the benefit of corporate America, not ...

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Primary care is a messy business. Nobody has just one simple problem, and no patient has all the typical symptoms for their diagnosis. Most don’t even tell us everything that’s going on. And most don’t follow their treatment plan completely. But this may be OK, since we often change our minds about what is right or wrong in the practice of medicine. Knowing what constitutes success in front line medicine is ...

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The serious diagnosis is a polite middle-aged woman with a hopeful smile sitting on the side of the bed, with her husband in the chair across from her, as you carefully tell them what it means to have ovarian cancer. The serious diagnosis is the teenager who just found out he has lupus nephritis -- without any other signs or symptoms of lupus -- and that he might be on hemodialysis ...

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In his State of the Union address, President Obama announced a precision medicine initiative “to bring us closer to curing diseases like cancer and diabetes.” The goal of precision medicine is to more accurately identify diagnoses and treatments based on a patient’s genetic information. This information will hopefully lead to better screening, earlier diagnosis, and more personalized treatment. But it’s hard to imagine that patients will get this kind of medical ...

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In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no ...

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