Next in a series. As a patient, you have probably had the experience of meeting a physician for the first time and very quickly becoming comfortable that he or she has your very best interests utmost in mind. The sense comes quickly; you become comfortable, less anxious. Unfortunately you may have had the opposite experience of encountering a well-educated, well-trained physician who, although technically an expert, left you cold. As a ...

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I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back. Let me explain. A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing ...

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The legislation proposals aimed at allowing physician assistants and nurse practitioners to act independently and deliver primary care services in place of physicians is a change in health care that we may face with an impending primary care physician shortage. It is an important topic for patients and physicians to discuss since ultimately those two groups will be impacted most by this change. Patients should be concerned with the quality ...

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The key change in medicine that has caused a escalation of costs, a decline in the quality of care, and an increasing shortage of physicians is the shift toward an exclusively business contract with society at the expense of the social contract. To differentiate the business contract from the social contract I will use the following example. One afternoon I see my neighbor hard at work changing her tire. If I ...

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“Nine of 10 doctors discourage others from joining the profession,” writes Daniela Drake on the Daily Beast. And stats say that by the end of 2014, about 300 physicians will commit suicide. What is going on? A few years back, practicing medicine was named the second-most suicidal occupation. Yet, it hasn’t stopped. The level of sheer unhappiness among physicians is on the rise. Being a doctor has become a humiliating undertaking. There ...

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I’ve based a huge chunk of my career on the assumption that evidence-based information helps people make better informed health decisions, have better health conversations with their doctors and ultimately leads to better health outcomes. Evidence is my stock in trade. I have spent many years translating evidence into a form that people can understand. I’ve written thousands of evidence-based articles across many channels. I’ve written position statements, belonged to guideline ...

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Patient noncompliance. I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time. We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often ...

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Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there ...

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The process of becoming an excellent physician is one of mastery.  The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult.  The leap from decision to clinician takes decades.  Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues. The apprentice guards his knowledge closely.  He bows to the alter of the sacred skill that he ...

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From MedPage Today:

  1. Temporary Fee on Big Business Funds Obamacare. The world of healthcare, like any, is full of haves and have nots.
  2. Grassroots Group Aims to Renew Primary Care. "Change is HERE. The future of primary care has arrived." The motto of Primary Care Progress, a 4-year-old grassroots organization advocating for interprofessional teamwork and a brighter landscape for primary care in the U.S., ...

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