Two months into my private practice career, I was assigned a “no doc” patient, a term referring to a child without a regular physician.  This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six-week-old son. He is your responsibility now.” If I have learned anything over the last 15 years, ...

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Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week.  She felt something was not quite right and asked me for advice. “Trust your instinct, go get him, and bring him home.” She brought him to my clinic the following day.  He looked mildly ill.  His vitals were stable; he was fatigued, slightly dehydrated, ...

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The market for medical tourism grows as Americans increasingly seek medical care outside of the United States and pay cash for services.  Patients know they can obtain adequate quality care in Mexico for out of pocket costs far lower than their insurance plans with high deductibles would cover.  Posting basic outpatient visit and simple procedure prices could benefit our independent practices in the same way.  The only thing worse than ...

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The Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program -- also known as meaningful use (MU) -- initially provided incentives to accelerate the adoption of electronic health records (EHRs) to meet certified program requirements.  Many physicians were mandated to change over to electronic records at the cost of tens of thousands of dollars.  Electronic records have never been shown to improve patient care or outcomes with statistical significance, ...

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Robert Kennedy, Jr. is an activist, author, and attorney specializing in environmental law.  He is the son of Robert "Bobby" Kennedy, a former U.S. attorney general, and the nephew of former President John F. Kennedy.  Kennedy is president of the board of Waterkeeper Alliance, a non-profit focused on protecting and enhancing waterways worldwide.  He has written a book about the damaging effects of vaccinations due to thimerosal, and to round ...

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U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared to 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant. While many researchers are scratching ...

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Recently, President-elect Trump selected Rep. Tom Price, MD to lead the Department of Health and Human Services.  Suffice it to say, this signals Mr. Trumps’ resolve and commitment to definitively repealing and replacing.  Dr. Price has already sunk his teeth into health care reform, having proposed alternative health care solutions in every Congressional session since 2009. As a physician myself, I am delighted at the prospect of having another doctor at ...

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The world is not going to end.  We witnessed a revolution earlier recently.  The people have spoken, and they chose the anti-establishment, street smart, government shrinking candidate who bucks the status quo.  We find ourselves in uncharted territory, with an unpredictable President-elect, who has unclear plans for health care.  Here is what we do know.  Mr. Trump is a successful entrepreneur.  Forbes describes the entrepreneurship pathway as having no ...

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As of September 15, 85 children from 33 states, the District of Columbia and Puerto Rico have died due to infection with the flu during the 2015-2016 season. Piper Lowery, who was a healthy and vibrant 12-year-old girl died from H1N1 Influenza almost one year ago.  Her mother, Pegy Lowery, has gone public with her daughters’ story, to urge more parents to get flu shots for their children.  I ...

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In a recent PBS interview, Mayo Clinic CEO Dr. John Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout.  His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession.  In my opinion, firing your physician is a risky proposition in light of the looming physician shortage. Burnout is an overwhelming ...

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Prior to her death, a courageous young woman named Jess Jacobs, who suffered from POTS (postural orthostatic tachycardia syndrome), wrote about the worst health care experience of her life.  It is a somewhat horrifying account of hospitalization in Washington D.C.  Her goal was to work toward meaningful health care changes in the system for the better. When I came across the story of another young woman afflicted with this disease, it ...

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Independent physicians are at the beginning of a challenging movement as we fight to stay relevant and solvent during the transition of health care from independence to “regulation without representation.”     In 1773, British Parliament passed the Tea Act with the objective to help the struggling British East India Company survive. Opposition to the Act resulted in the return of delivered tea back to Britain.  Boston left the ships carrying tea ...

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Recently I wrote about empowerment and the importance of letting patients make their own health care decisions.  Our job is to make sure patients are given information and then allowed to choose the best option for them.  Maybe we should even embolden patients; give them confidence and encourage them to take more control. Physicians tend to feel more comfortable advising according to the “standard of care” and ...

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Growing up during the 1970’s and 80’s, Little House on the Prairie was an iconic part of my childhood.  Doc Baker was the physician and veterinarian for all of Walnut Grove, in spite of limited resources.  Medical lessons were everywhere in the beloved television series:  Mary experiencing onset of blindness (most recently attributed to viral meningoencephalitis, likely from measles), the death of Laura’s infant son by unknown cause, and Rose’s ...

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Referencing a recent New York Times article “What Kids Wish Their Teachers Knew” got me thinking about both sides of the coin.  Physicians are human beings and sometimes this fact gets lost when a patient is angry or frustrated seeking help from the medical system.  Here is a primer on what I wish my patients knew. (This is a companion piece to "I wish my doctor ...

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Recently the New York Times published an article, "What Kids Wish Their Teachers Knew." As a pediatrician, I have spent a good part of my lifetime fighting for the health and welfare of our young people.  They are the future.  We owe our children a safe, caring, stable childhood whenever possible. Outside of a supportive family, a long-term family physician or pediatrician can be an important role model ...

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Give me technology which improves my life and that of my patients, or give me death. Medical records must be informative, efficient, and flexible; like the physicians they serve. For me, a medical record does not contain just a collection of problem lists, prescribed medications, and immunizations; it is a noteworthy account of the health care provided to another human being over a lifetime. Recently, I attended a baby shower of ...

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In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical ...

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Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable.  Did you notice a particular word missing?  Yes, I missed the word physician too, because they have been left out of the conversation entirely. Measuring quality health care by ...

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My thoughts settled on the Frank Sinatra song, "My Way," when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings.  We closed the office that Friday to allow three full days to get settled.  However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck. “All we need is a stethoscope, ...

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