It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors -- in what they only half-jokingly called “Doccupy” -- that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. ...

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When looking to examine patient-centered medical home data, there’s no better place to start than the 26-month evaluation of the multi-site National Demonstration Project. Begun in 2006, with results published in 2010, this federally funded project included an array of repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months, using patients from 36 family practices that were randomized into two groups: those practices that received ...

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As the patient-centered medical homes (PCMHs) train charges forward along with implementation of the Affordable Care Act, dollars are taken directly out of our health care system to certify providers in a method with no proven benefit. And, while there is a marked shortage of primary care providers nationwide, funds that could be used toward providing the direct provision of, or access to, health care are instead devoted to accreditation, ...

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Patient-centered primary care medical homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care patient-centered medical home (PCMH), the more you want to ask, “Well, of course – how ...

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503591-cory-monteith-glee-golden-globes-617-409 Hollywood stars, like Glee’s Cory Monteith, aren’t the only Americans struggling with addiction that kills. Monteith, who died of a heroin and alcohol overdose, exemplifies the public health tragedy that is opioid overdose deaths in America. The fact is, there is no greater public health issue. From as far back as 2008, we have been dying more from poisoning – almost all poisonings ...

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The more complex and high stakes a health care decision is, like with genetic testing and mastectomies, the more difficult it can be to find your way. There are no “right” answers, only guideposts to help you choose a path that is best for you. Decision-making alone. When my kids went to camp in the fifth grade, they got to experience something called the Solo Hike. Counselors took them up into the ...

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There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing ...

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The first time I wrestled with the issue of whether to get my breasts cut off, I was in my early forties.  Partners in life, my breasts had done right by me. They delighted me in all their underwhelming adolescent glory. Then they’d been a source of panting, wriggling joy for so much of my adult life. They’d amazed me after pregnancy when I became a fount of Bessie-the-cow milk ...

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I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health and sustain behavior change, even in people suffering from profound mental illness. But when it comes to using these tools for public health, there are two problems. The first is that each message (whether via phone call or text) costs money. The second is that it’s quite hard ...

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Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I'd call the tenth-patient-of-the-day challenge? Here's what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn't show at the smoking cessation ...

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Studies show that many people faced with home loss and housing uncertainty can take a tremendous hit to their health. If you’re going through difficult times, and worried you too may lose your home, what can you do to try to buffer or reclaim your health? Here are some tips for ways to counteract some of the toll that constant stress (and the insomnia, distraction and desperation that go with ...

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Part three of the three-part series, Let’s Pay Popular People More! Perhaps you remember Sam, the chronic inebriate whose story I shared to discuss the pitfalls of basing doctor pay on patient satisfaction surveys. Looking at his discharge papers, I wondered who helped Sam fill his survey out, and how much their "help" affected the results. After all, millions upon millions of dollars are already now at stake for ...

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Part two of the three-part series, Let’s Pay Popular People More! Take a moment to ask yourself whether any of these categories describe you or someone you love:

  • Never had cancer
  • Psychologically distressed
  • No regular health care provider
  • No health insurance
  • Lack confidence in self care
  • Avoid doctors
  • Minority race
If any of these terms describes you or a loved one, then you are statistically more likely to give a doctor a lower Read more...

Part one of the three-part series, Let's Pay Popular People More! My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of ...

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I went to needle exchange to hang out. You may be asking yourself what a soccer mom from the burbs is doing perched on a folding chair in the parking garage of 101 Grove on a dark November night, surrounded by syringes. I was there as a guest observer because I’m working on a series of articles about mortality and homelessness, as part of an Annenberg California Health Journalism Fellowship I ...

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Here’s your multiple choice question to set the stage: what percentage of all physicians do you think should be sued for malpractice? Would you say one-in-ten doctors ought to be sued? Or one-third? How about every single one of them? Let’s make it one claim per doctor, nationwide. Does that sound reasonable? Keep in mind that even defending yourself against a suit will cost on average $40,649 per claim, ranging from ...

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It was kind of amazing how little coverage the recent report on healthcare in our prison systems got. Heck, you may be thinking, I don’t think that’s amazing – why waste airtime on that topic – why should I fret and worry about the healthcare that prisoners get when my child is burning up with fever and coughing up a lung and I can’t even afford to take her to ...

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You may be wondering why Stanford Medical School’s new genetic interpretation class – the one that offers medical students the opportunity to study their own genes – has made the news. After all, what better genes are there to study than your own? And if you were a medical student, wouldn’t you want to have your medical school subsidize 80% of an $800 test as part of your curriculum – ...

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As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours. Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass ...

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The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area. And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote ...

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