The following op-ed was published on July 18th, 2010 in USA Today. A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted. Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point ...

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An excerpt from White Coat, Black Hat. by Carl Elliott A few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given by a member of the urology department. The doctor’s PowerPoint slides had a large, watermarked logo in the corner. At one point during the lecture a ...

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by Robert Graham, MD As the nation works to reinvigorate primary care, a lot is riding on the medical home. Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address ...

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Dr. Marcus Conant, among the first AIDS specialists in San Francisco, who for decades had one of the world’s largest private practices for patients with AIDS and HIV, has left town and moved to Manhattan. He has been a physician for nearly 50 years, but like many doctors, in the past decade he has become increasingly frustrated with insurance challenges that made running a private practice unnecessarily complicated and a financial ...

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Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events. With the recent progress ...

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Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult.  It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life. Wouldn’t it be nice if the most pleasurable things ...

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Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”
In the study, ...

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In an editorial published the New York Times, a strong argument was made for studying the relative effectiveness of screening colonoscopy and sigmoidoscopy.  Based on a review in JAMA of three studies conducted outside the US that showed no difference in colon cancer mortality or incidence when the two procedures were compared, the Times proposed a US study to answer this question. Comparative effectiveness (CE) research, a relatively new concept in ...

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I heard a prominent speaker talk about studies at the National Institute of Aging.  The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability.  These studies are terrific, and worthy of funding. I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability.  Research in prevention will not help these patients.  I asked: where is the ...

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If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on.  Why is that so hard sometimes?  It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them? Sometimes doctors blame the patient Years ago I got a terrible abdominal pain.  I could only explain that it felt like ...

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