We’ve all heard the phrase, “survival of the fittest.” It suggests that in the competitive, “free market” world, it is the “best” who survives and it’s “the cream” that rises to the top.  But is that true for doctors?  Do patients get better care when competition rules the health care marketplace? A few years ago, a doctor from a large primary care group contacted me to give a talk to the ...

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My next patient was a healthy man in his early 20s following up for eczema.  His case had not been severe, so I had anticipated that the prescription strength steroid cream I had given him would have addressed his symptoms faster than I had promised.  His chief complaint had been itch—a symptom—something that he was experiencing.  He hadn’t even noticed the rash.  It was what one would call “bread and ...

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When we think about the technology revolution, we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good a result, is usually seen as a virtue -- unless one is a doctor. In these times of fast information, we find ourselves bombarded with surveys. Part of the downside of ...

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