Before managed care became the dominant force that it is, patients and doctors had the opportunity to get to know each other well. Doctors treated multiple generations within families. This helped establish a strong bond among patients and their doctors. While it might have intended to mean preventing expensive care, managed care began to mean organized care. Run by institutions such as health maintenance organizations. Insurances began to decide which doctors you ...

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You are a child of Thanos. "Hear me and rejoice!” “You have had the privilege of being saved by the American College of Cardiology and the American Heart Association. (Yeah, I know we said the same thing when we prescribed low-fat diets to decrease the risk of heart disease, but you gotta give us a pass on that one.”) “Based on our research, we have found 100,000,000 of you are ill.” “But we can ...

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When I hear pundits going on about the Medicaid work requirements, I think of my father. He has worked in the United States for twenty-four years, taking on the role of a handyman, migrant farmer, truck driver, construction roofer, dialysis patient transporter, and elder transporter. His limited English and third-grade education land him in low-paying jobs with limited hours and an oversupply of workers — resulting in frequent periods of unemployment. For ...

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Absent a last-minute, lifesaving intervention, after 20 years of reviewing and summarizing clinical practice guidelines in a continuously updated database, the Agency for Healthcare Research and Quality's National Guideline Clearinghouse (NGC) will go offline on July 16th. Prior to its untimely death due to budget cuts, the NGC not only served as a one-of-a-kind online resource for clinicians, researchers, and educators, but raised the bar on guideline ...

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Primary care visits are never quick; we don’t give much advice over the phone or online; and we prioritize the government’s and insurance companies’ public health agenda over our own patients’ concerns. Imagine health care as a retail customer experience for a few minutes: Imagine you’re going to Walmart to buy a bag of dog food, a new coffee maker or to equip a small kitchen in your newly built mother-in-law apartment. 1. ...

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We’ve all heard the excuse or explanation that "it’s society’s fault," to explain someone’s failure.  We hear expressions like this often when an individual has committed a crime or simply failed to succeed.  Personal accountability is diluted as we are told that this person came from an imperfect home, had no role models or ample education. These arguments are often wielded by those who have been favored with society’s blessings and ...

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Dr. Eugene Gu. He is -- was -- a surgical resident at Vanderbilt University. His resume exemplifies academic perfection: valedictorian in high school, undergraduate degree from Stanford, medical degree from Duke, surgical residency at Vanderbilt. He also founded his own research company. Not once throughout the span of his academic or professional career would one have any reason question his capability or competency. But several weeks ago Vanderbilt fired him, citing “performance” issues. Why? Because ...

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They are intangible, as intangible as the space that the death of a loved one leaves behind. There is emptiness where there was once-occupied space. The past tense supersedes the present and definitely any aspect of the future tense and verse. Where they are supposed to be — in our homes, in our cars, at our kitchen tables, out to dinner with us, in our arms — there are only ...

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I am a hospitalist at a safety-net hospital. Through my work, I have come to understand how our daily decisions — filtered through our own biases — influence how health care is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K. He was in his 40s, well-kempt, soft-spoken and had the good habit of looking people ...

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Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs -- either with no insurance or insurance that is out-of-network -- they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services. After the post, I was inundated with angry tweets and emails, mainly from emergency medicine ...

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