When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot. I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never ...

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I have two refrigerators. The full size, expensive version, sits in the usual location in the kitchen.  The small black one rests idly in the basement.  Excluding this morning, of course, when I dragged it up the steps and begrudgingly coaxed it back into action.  Let me explain. Six months ago my old refrigerator started acting up.  Somewhere around year five, it’s motors groaned, its coolers moaned, and all the sudden the ...

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TEDMED-WIBLE-PHOTO-shrink Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below: Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at the ...

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The emergence of direct primary care (DPC) has the characteristics of a social movement, defined as a “purposive and collective attempt of a number of people to change individuals or societal institutions and structures.” Moreover, the DPC movement has thus far succeeded largely because it is based on a guiding set of strongly-held principles from which its founders have not wavered.  The concept of direct primary care as a reordering ...

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Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society. Physicians have always been charged as patient agents to advocate for patients' best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often ...

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I feel that I have been spending way too much time as a “chronicler of the decline,” to use von Mises' phrase.  The secular trend in health care (literally spanning the last 100 years) is one of increasing centralization, consolidation, and reduced choice.  Nevertheless, there are some promising developments that give me hope for a better future. Here are five notable trends, in no particular order: 1. Direct patient care. Direct care encompasses all ...

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Health care remains one of the few services that require people to have a face-to-face interaction to obtain access. But more and more consumers are questioning that reality, and change is on the way. In January 2015, the Centers for Medicare & Medicaid Services (CMS) issued a new provider reimbursement code for non–face-to-face health care services for patients who have chronic medical conditions. A new CMS code may ...

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As the last line of defense in soccer, the goalkeeper holds a privileged position. She’s the one who can see the whole field unfolding in front of her, and she’s the one who must come up with big plays when the game is on the line. When I was a goalkeeper, I lived for the pressure, drama and chance to be the one to make the big plays for my ...

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According to a study published in the New England Journal of Medicine, the use of dietary supplements sends an estimated 23,000 Americans to the emergency department each year. Approximately 25 percent of the ER visits that were supplement related were by adults who were using herbal weight loss products. Another 10 percent were caused by adults consuming “energy products” (although people using energy drinks were excluded from the ...

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Twenty years ago, I changed the name and focus of the annual physical I offered my patients. I designed a new form on my laptop with Geoworks, my favorite DOS-based (pre-Windows) desktop publishing program, and rolled out my “annual health review.” I explained to patients that many of the things we used to do in routine physicals every year had proven to be of little value, but there were more and ...

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