As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas.  After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have ...

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Eat what you kill. Sounds like a mantra from a survival reality show, right? Akin to “eat or be eaten,” “kill or be killed.” It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service health care culture. How ironic, the application of these words to this profession. It was explained to me essentially as: “Every man for himself, and you’re a minion. You are expected ...

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When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in health care in the world he had to appeal not so much to their morals, but their pockets. There is much piety about the NHS. It is the envy of the ...

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On September 30th of this year, the Children’s Health Insurance Program (CHIP) ran out of federal funding. While CHIP has not received as much publicity as the Affordable Care Act (ACA), it has had a major impact on the American population: providing health insurance for 9 million children who would otherwise not be insured. Despite its success, there is currently a debate about the funding of CHIP. CHIP, which was passed ...

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The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.” In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people ...

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Baseball, like medicine, is deeply imbued with a sense of tradition, and no team more so than the New York Yankees, disdainful of innovations like placing players’ names on the backs of their jerseys and resistant to eroding strict standards related to haircuts and beards. It’s why doctors and patients alike should pay special attention to why the Yankees parted ways with their old manager and what they now seek instead. In ...

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Whether by design or by necessity, it appears that single payer is inevitable. Economic reality demands it. Some external force needs to be applied to counter the cost of rapidly expanding medical technology coupled with the political and legal pressure to make that technology available to as many people as possible, regardless of their ability to pay. The problem is certainly not new, but we are at the point of having ...

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Over the past several years there have been numerous reports on the rates of death and injury in children with firearms.  In fact, a 2-year-old child recently accidentally took his own life in Philadelphia recently.  Although the studies don’t entirely agree, two things are certain; 1 death is one too many and children don’t need to exercise their second amendment rights. The United States has by far the highest rate of ...

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Following a relatively routine doctor appointment, I received my bill for over $1,000. I rubbed my eyes, hoping to find an overlooked decimal point. I didn’t. My experience is not unique. We have a problem in the U.S. We pay over $3 trillion annually for health care — about 18 percent of our GDP. No other developed nation spends more than Read more...

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate ...

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