I think the time has come for us all to do a little more than put our 2 cents in. Our health care system is a mess, and while many of us fighting in the trenches and taking care of patients are working to make things better (despite the best efforts of much of the rest of the system), the challenges and ...

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Late last year the New York Times reported that Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, had resigned for failing to disclose his conflicts of interest at professional meetings and in scientific and medical journals. The Times report says that Dr. Baselga -- who also served as physician-in-chief at the center -- “had failed to disclose millions of dollars in payments from health care companies in ...

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Recently, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46 percent of survey respondents viewed the ...

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“Triage” is French for “to sort.” It developed as a concept on the battlefield as a way to address injured soldiers and ensure that care was provided to those most in need. In the emergency department, triage is usually the responsibility of a trained, experienced nurse. Patients present to the emergency department, the nurse obtains a history and may perform a cursory ...

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As a family physician in the trenches, I routinely see blatantly poor medical care in the history of my new patients. Far too many people get unwarranted medications and tests, while important things go unrecognized or unaddressed. This paradox is maddening. We must do better. To this end, policymakers have developed programs to promote "quality" and "performance" among clinicians. The main approach has been altering payments to serve as financial incentives and ...

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A young male patient checks into the emergency department (ED) and is brought back to a room for an ankle injury he suffered the day before. He states that he twisted it while doing some indoor rock climbing and tells the triage nurse that it is swollen and tender, but that he can walk on it. His vital signs are registered, and he is brought back to a room where ...

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Recently the CEO of a large health care network stated: “Market forces don’t apply to health care.” Of course, economic and political forces apply to health care.  Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmaceutical companies, pharmacies, and government agencies) formulate health care policy to enrich themselves at the expense of patients and small, independent medical practices. As an independent family doctor, my practice’s existence is in jeopardy.  Small physician ...

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I started my medical career late. Really late. By that time, I’d lived a few lives. I’d earned a boatload of initials. I’d changed husbands, languages, and continents. I’d written a useless novel, and I’d been a Mary Kay lady. One day over lunch as I was looking for something to do with myself, my husband suggested medicine. I spent the next nine years immersed in my medical training, feeling guilty ...

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With the 2020 election cycle already moving into high gear, we are hearing a lot about Medicare for all. But is it a serious campaign promise, a catchy bumper sticker or a viable national program? Supporters suggest it will be a panacea for our nation’s health insurance needs. Others are less sure. And some are downright opposed. So where do we go? As a starting point, there are things we can ...

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One of the most popular topics in health care is the idea of universal health care coverage. You know the soundbites: “Medicare for all.” “Single-payer system.” While universal coverage sounds desirable to many, some factors must be considered. In this post, I’m going to provide an aerial view of this complicated topic. My goal is to translate this issue into patient-friendly language that all of us can understand. This topic isn’t ...

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