It had been a hectic day in the urgent-care clinic of my large family practice, and I was starting to worry about the time: My last two patients had put me thirty minutes behind. I felt relieved when I saw the note for the next patient: "Seventy-four-year-old female with UTI." A urinary tract infection! This should be quick and uncomplicated. I walked into the room to find a well-dressed older woman seated on ...

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Mr. Dwyer isn't my patient, but today I'm covering for my partner in our family practice office, so he's been slipped into my schedule. Reading his chart, I have an ominous feeling that this visit won't be simple. A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath. He suffers from both congestive heart failure and renal ...

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My patient Maria sits before me, looking vaguely distressed. She's returned for a follow-up visit, six weeks after our first. The morning is half over, and I'm clipping along, staying on time, using the new electronic medical record system (EMR) without a glitch and with a sense of satisfaction. Three months back, when I joined this small-town practice as part of my new position as a health-system medical director, I found ...

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