As an academic internist, over the past five years, I’ve been hearing more and more about social determinants of health.  I have read countless journal articles comparing health outcomes; I’ve attended grand rounds on the subject; recently, our electronic medical record changed to incorporate a tab on social determinants of health into the patient’s chart.  As a course director in the medical school, I’ve incorporated this topic into ...

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The COVID-19 pandemic has turned our lives upside down.  It has wreaked havoc on the economy, leaving many jobless, and many industries questioning where their future lies.  In my view, it has brought the weak infrastructure of the U.S. health care system to a breaking point.  These deficiencies were already present: limited public health prowess, hospitals' inefficiencies, poor coordination of care, and disjointed health care messages between federal ...

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As the coronavirus pandemic continues to expose shortcomings in our health care system, an outdated law in many states limits the ability of specific health care workers, physician assistants (PAs), to deploy and provide emergency care. In Washington State, a PA must have a delegation agreement filed with the Department of Health, which identifies a supervisory physician for that PA. The scope of practice of each PA is defined by ...

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We are in the midst of an unequaled juncture in history, one in which we find ourselves primarily armed with the ability to distance ourselves physically from one another. In the United States, we have observed on multiple occasions over the past several weeks how some citizens have chosen to defy social distancing guidelines from the Centers for Disease Control and Prevention ...

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Many government officials have begun to lift some restrictions on elective surgeries and procedures for hospitals. This means that some of those of us in medical professions not on the COVID-19 front lines will be returning to a workload closer to the pre-pandemic phase soon. For weeks, my radiology department has been relatively empty. Some have felt that having fewer personnel in the department has left us unnecessarily short-staffed for patients ...

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The COVID-19 pandemic has led to unprecedented upheaval of the U.S. health care system. For decades the United States has stood out among peer nations as the only country with no universal health care system. And now we are learning just how problematic it is to tie insurance to employment -- an unintended consequence of employer workarounds of World War II wage freezes. Nearly
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My parents’ pharmacy is a low slung, white brick building on the corner of East and Main. The front door is strung with silver bells;  a jar of red licorice sits by the cash register; automatic scooters line the front of the shop, gleaming like cars at the races. Most days, the pharmacy is a small business owner’s dream. The phone rings off the hook; and with twenty-nine employees, there’s always ...

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Over the last 100 years, the U.S. has had to respond to five avian flu pandemics. The most severe was the 1918 avian influenza infecting 1/3 of the world’s population and killing 650,000 Americans. It was also the last time wide-spread containment, mitigation, and isolation strategies were used in the U.S. Seldom mentioned about the 1918 pandemic are the three “waves” or cycles of resurgence and the subsequent deaths associated ...

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As Americans, we rarely question the authenticity or relevance of our constitution. Although segments are hotly debated, and parts are amended over time, the document stands as a light of legal and ethical truism. The foundation of our country and its revolutionary ideals served a purpose – to escape the grip and tyranny of the British empire. Before our independence was won, however, America had some soul searching to do. ...

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“How much will this cost me?” This is the last thing that a patient with COVID-19 should have to think about, but this is a major concern for the at least 27 million Americans facing the pandemic without health insurance. These individuals include construction workers, drivers, and cashiers, many of whom must continue to work because they are financially strapped or because they are essential personnel. As ...

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