Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it? A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a bill calling for more education, presumably physicians as a prime target. We’ve actually been down this road before, but possibly not how you think. The politicians and pundits used to complain ...

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All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients. A recent study from researchers in Boston ...

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I’ve read several articles recently reporting on a shortage of geriatricians. The writers have some clear misunderstandings of who actually cares for our elderly and where they come from. Susan Jaffe writing for Kaiser Health News stated that the American Geriatrics Society (AGS) estimates that the nation will require 30,000 geriatricians by 2030 to serve our aging population. This is probably true, what the AGS believes. She goes on ...

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A colleague recently told me of a patient encounter he had in an emergency room. When he picked up the chart, it described the patient as a 62-year-old woman complaining of epistaxis, or a nosebleed. He walked into the room and saw a perfectly well appearing 62-year-old woman. There was no blood on her clothes and none on her face. Her nose was not bleeding. When he asked her what could he do for her, she said ...

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Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much. For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every ...

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The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins. One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication ...

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As much as I have given the "ologists" and other members of the dysfunctional U.S. health care system a hard time in previous posts, it’s only fair that I call out bad family medicine as well. I have a great example. I recently saw patient who is relatively new to the area who had seen another family physician in my community. He is 39-year-old male, and his only significant potential health ...

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There will are lots of things I hope improve in our health care system in 2015, but I’ll just mention one wish today. My wish is that the worthless wellness programs that have sprung up all over corporate America will fade away. I have criticized these programs in the past, but more ammo has come to light. A recent article in Employee Benefit News lists seven factors explaining how wellness programs are not ...

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A recent report from Rutgers University entitled "Unhappy, Worried, and Pessimistic: Americans in the aftermath of the Great Recession" found that 70% of respondents described the typical American worker as not secure in their jobs and 68% of workers are highly stressed. A quote from the study is, “The typical American worker lives in a precarious and doleful existence -- unhappy, poorly paid and fearful of losing his or her ...

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I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost. Let’s ...

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In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby -- the kindly, accessible, but straight-talking television doctor -- is dead.” If he believes that, Dr. Oz needs to get out of New York. At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty schmaltzy ...

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"Patient-centered." It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple. A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned. She claimed that some patients ...

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Here we go again. There is yet another round of evidence of how the physician workforce hole we’ve dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side. One recent study appeared in Academic Medicine. Clese Erikson and colleagues surveyed a random sample of 4th-year medical students in 2010. Only 13% of the students stated they ...

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The American Heart Association and American College of Cardiology recently published new guidelines for screening and treating cholesterol. In some ways these guidelines are more like the British guidelines. Instead of setting up doctors and patients to fail by calling for certain cholesterol number targets as in the old U.S. guidelines (i.e. LDL level below 100), they instead focus on putting higher risk patients on drugs called statins and then ...

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Family physicians told us they are more comfortable with uncertainty than the "ologists." For a little history, the Future of Family Medicine project published in 2004 identified this mental attribute as an important defining skill of family physicians. This ability manifests itself across the entire spectrum of family medicine. An example is reassuring a young mother that her infant with a fever will probably be fine – and ordering no ...

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I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.

Hey Dr. Young, I’m looking for some basic mentoring advice.  I’ve been moonlighting at ZZZ Urgent Care for about a year.  Not my favorite work, but oh well.  I don’t routinely prescribe antibiotics ...

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Several physicians contribute regularly to BMJ. One of my favorites is a GP in Glasgow named Des Spence. Through their writings, I have gained a glimpse of the challenges faced by GPs in the UK, and the broader culture in which they work. In two of his columns this summer, he railed against various early detection movements in the UK. In one column, he protests against Alzheimer’s disease advocates who ...

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A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck ...

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I’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state. The issue of cost came up and two colleagues in private practice told ...

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Doctors love to talk about tort reform – states passing laws to put limits on awards such as non-economic damages for harms such as pain and suffering, and on the legal process of suing a doctor for malpractice. They speak of defensive medicine – the practice of ordering extra tests, treatments, and days in a hospital to cover their medical-legal butts. Texas passed a comprehensive tort reform law in 2003 ...

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