Remembering why we got into medicine in the first place can often soften the edges of long, difficult days. My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to ...

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As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures.  Patients pay me (albeit mostly indirectly) for my cognitive skills.  But we live in a culture that seemingly rewards procedures more that pure cognition.  Now I understand that procedures are not mindless.  Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure.  But cognition without procedures seems undervalued. The ...

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It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy.  Membership has dwindled such that only 1/4 of physicians now belong to its ranks. The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA ...

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Most of us would agree that health care costs are too high in America.  They must be controlled or else we won’t have a sustainable health care system here.  And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts.  But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums ...

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I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student -- bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my ...

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There’s an elephant in the room, one that’s preventing patients from getting the most out of their visits to the doctor -- and the name of that elephant is embarrassment. It’s not unusual to feel uncomfortable about some of the more intimate aspects of your health, but too often this discomfort turns into outright embarrassment.  This embarrassment can lead to omissions, which in turn make it impossible for your doctor to ...

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Everyone agrees that the US healthcare system is too costly.  The challenge of public policy is deliver higher value by improving quality while reducing costs by eliminating waste and increasing efficiency. Historically physician compensation has been tied to productivity, which encourages procedures and over-utilization. How can we motivate physicians to provide preventive, cost effective and quality care without incentive programs? Alfie Kohn in 1993 published ”Incentive Plans Cannot Work.” Clearly, poorly ...

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Doctors are burned out and they don’t enjoy their job as much as they used to.  But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed.  There are issues that doctors rarely face: unemployment, inability to pay their rent and food with their paycheck, and lack of health insurance. These benefits ...

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Norman Rockwell never imagined a world where visiting a doctor could be compared to a trip through a Starbucks drive-thru. The days of shooting the breeze with patients and family members have been relegated to the “Good ole’ days” museum right next to Rockwell’s paintings portraying the doctor as more than just a healer, but a trusted friend. What happened to those days? With challenges like increased patient volumes and ...

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He looked ahead, seeing his feet on the hearth. There was smoke rising from one of the three logs, and he marveled at the small flicker of flame that stretched up and ignited the smoke that swirled above the log, dancing briefly somewhat joyously, then gone again, smoke returning. "You can't say you weren't warned," she said. He sat, reflecting on her words. So much years of work, so much effort, breadwinner, ...

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