Like prep sports or prime-time television, medical meetings have seasons. In the spring and fall, my calendar fills with invitations to speak. I try to get to the venue a few hours before I’m scheduled to speak, so I can “take the pulse” of fellow doctors, asking them about their practices, patients and the future of medicine. Figuratively speaking, the industry’s pulse is racing with fear. I’ve observed that in just the past ...

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An excerpt from Prescription for Bankruptcy: A doctor's perspective on America's failing health care system and how we can fix it. Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue ...

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For my students in 2018, it's difficult to imagine an era when there was no such thing as evidence-based medicine (EBM). When I started medical school in 1997, though, the term had only been in use for six years, having been introduced by Dr. Gordon Guyatt at McMaster University (though EBM's intellectual origins can be traced to several key individuals). When I tell trainees how recently EBM began, ...

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I remember when I started nursing school about a decade ago, that there was a near militant attitude describing the nursing shortage. School administrators, politicians, and journalists hopped on this easy bandwagon and talking point. Research and polls of dubious quality rode the tidal wave of popular opinion. Unsurprisingly, their genesis in an echo chamber yielded predictably confirmatory responses. As graduation time was fast approaching, the class began to job ...

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The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day. A new poll by the American College ...

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When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends! Let’s separate fact from fiction. Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are ...

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The beverage industry derailed the movement for soda taxes in California by convincing state elected officials to pre-empt local taxing authority in exchange for cancelling a ballot initiative that would have made all new taxes difficult to pass. But taxes are not the only way to reduce sugary beverage consumption in California or the U.S. as a whole. The beverage industry has come up with several ideas on how to ...

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In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings. To simplify things a bit, every health care system on earth has three main stakeholders:

  1. Patients
  2. Physicians and clinicians
  3. Administrators
Yes ...

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There are now more than 700 million obese people worldwide, 108 million of them children, reported the New York Times in 2017. In Brazil, food giant Nestle sends vendors door-to-door hawking its high-calorie junk food and giving customers a full month to pay for their purchases. Nestle calls the junk food hawkers, who are themselves obese, “micro-entrepreneurs.” Big Food is increasingly targeting poor countries as “emerging markets” ...

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Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time. Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? ...

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