Becoming a physician in 2019 presents its share of challenges. Providers must deal with reimbursement rates that remain a fraction of their previous levels, adapt to a fee-for-value model, adopt ever-advancing technology as an integral part of care delivery and accommodate a patient-provider dynamic that favors patients — who now demand choice, autonomy, affordability, and transparency. These developments starkly contrast conditions at the turn of the century. Still, they don’t seem to ...

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Most new cancer treatments haven’t been proven to help patients live longer or feel better. Instead, they delay the growth of tumors — which may be faster to measure but doesn’t necessarily indicate a tangible benefit for patients. But you wouldn’t grasp that sobering fact from some recent news coverage:

  • A headline in the UK’s Telegraph about the drug olaparib (Lynparza) read: “Revolution’ in prostate cancer care as off-label ...

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Next in a series. The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge ...

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"She is too direct." “She sounds overprepared.” "She is just not that lovely to hear."   These are just a few pieces of “feedback” that podcast producer Dr. Shreya P. Trivedi has heard about women’s voices over the years. And then suddenly it occurred to her, she had never heard any comments on a man’s voice or the way he speaks.  Though women have come a long way from ...

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It’s that time of year when the weather outside is growing colder, the evenings seem to kick off way too early in the day, and the decorations around town remind all of us all of the fast-approaching holiday season.

But for many of us obstetricians, this can often translate into anxiety over how often we’ll be pulled away from long-scheduled holiday activities to rush to the hospital ...

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There are many disparities in health care. Black mothers have a much higher rate of maternal death than do white women. All women are less likely to get guideline-advised cardiac care than do men. Among the many such examples, perhaps the hardest disparity to solve is that of the poorer access to health care faced by rural communities. People living in rural counties have higher death rates from cancer and ...

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I have noticed a profound lack of self-esteem in our profession. I am concerned. Concerned for us, and for our patients. We are the most noble of professions. However, we have compromised our morals, values, ethics, and virtues. We are now living, operating, and existing in a constant state of contradiction. It is tearing us apart from within. We continue to work for less, with fewer resources and ancillary staff, all while ...

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Dear Congress: For the vast majority of you, I am not your constituent.  But you should listen to me anyway.  I am writing to show you that health care in America is not a political issue; it is a human one.  The same can be said for immigration or education or any other issue that you work on. Let my patients explain this for me. I walk into clinic to a full ...

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On January 22, 1973, Roe v. Wade established a woman’s fundamental right to abortion nationwide. Roe v. Wade should not be overruled because women having universal access to abortion services means women have the right to choose what is best for their health care. This is how health care should be in that if there is a viable medical option for the patient to pursue, the patient should have the ...

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“What challenges do you see yourself facing as a doctor?”
I’m sitting in a suit, facing a young Asian woman with black, round glasses across a desk. On the desk in front of her is an iPad, and she sits cross-legged, hands resting on her legs. I’m in my interview for medical school, and the woman across me, who introduced herself as Angela, is awaiting my response. I pause and mentally check ...

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An excerpt from Mind Bubbles: Exploring mindfulness with kids. I am not a pediatrician.  My training as an OB/GYN taught me to care for mothers-to-be and bring their babies safely into the world—and then hand them over to the waiting pediatrician.  I am also a mom and mindfulness teacher, however, ...

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This time last year, I took the podium at conferences as far away as Dubai to deliver my keynote speech entitled, "On The Cusp Of Life And Death, Choose Life." My talk highlighted the professional and personal development opportunities that show up as doctors, nurses, and parents navigate the challenges in the neonatal intensive care unit (NICU) caring for preterm and term newborns on the cusp of viability due to ...

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Harvard Medical School student Chloe Li typically dressed in scrubs or an efficient, professional outfit as she went about learning to care for patients in the intense, year-long clerkship program where I teach.

For her capstone presentation on graduation day, though, she wore a cream-colored wrap-around dress of luscious silk, tasteful jewelry, and an up-do hairstyle. She had clearly put a lot of care into these preparations. She ...

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Despite growing older, the contents of my phone calls back home have remained the same. However, the contents of my life have not. Conversations with my parents consist of what I plan to cook that week or how I'm feeling about my workload, but rarely do I share the details of my research project or my struggle to conceptualize the nephron. This is not because I don't want to share these ...

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National attitudes have greatly shifted over the last 25 years towards the idea that mental and emotional well-being are vital to a person’s overall health. Today, nearly six in ten Americans have sought or want to seek mental health care for themselves or someone they love. While stigma and costs persist as primary barriers to progress for solving the mental health crisis, the key issue—as we have ...

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I am a 38-year-old board-certified OB/GYN. I have been married to my husband for 12 years. I am the mom of two young boys. I drive a Subaru. In short, I am the complete opposite of the demographic that rules TikTok. Never heard of TikTok? It’s OK – until recently, neither had I. TikTok is the fastest growing social media platform that seems to have exploded overnight. The app, which is famous for ...

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There is always that one patient. The one with the over-attentive, aggressive family member, who writes a complaint. The one you tried to help, but no matter what, the wait was too long, the nurse too unfriendly, you didn’t sit enough, you didn’t reassure enough, pain meds took too long, you didn’t make them feel important. That one patient who has the time, negative energy, and physical health to write ...

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From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label "toxins" already suggests that these are noxious agents. If one accepts this premise, it is entirely ...

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Back in 2016, my hospital, also my employer, changed the EMR. I was fully integrated into another EMR, so changing was not on my to-do list in the later part of my career as a diabetologist. As you would expect, the transition was a nightmare and took me to a new low in my life. Crying in my wine became my new norm. I became distraught, felt imprisoned, and felt that ...

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I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, "I hate civilian medicine." I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. ...

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