I have been a way from blogging for a a bit and tried to clear my head a bit with a vacation skiing.  I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint.  It was nice to notice that there's a whole world ...

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"A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)" begins the press release. As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the "CLER Program:"

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of ...

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By now the world has heard the remarkable news. CVS Caremark will no longer be selling its tobacco products in any of its stores.  Locked and loaded with the news, the American Heart Association, American College of Cardiologists, local public health experts, Phillip Morris, and even the former-smoking president of the United States was quick to applaud the news by publishing press releases. But when press releases and major announcements of ...

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How should patients determine the quality of their doctor? This is an interesting question that has now reached mainstream media status as evidenced by a Wall Street Journal article by Laura Landro, a very accomplished veteran health care reporter. With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) "exceptional, world class" medical educators and longstanding ongoing mandated continuing medical education ...

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Most of us would agree that health care costs are too high in America.  They must be controlled or else we won’t have a sustainable health care system here.  And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts.  But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums ...

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As we enter the New Year, I like to reflect on where we've been and where we're heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care. It's strange really. I thought I'd try to make some realistic predictions of what patients should expect in the year ahead now that the "Patient Protection and Affordable Care Act" (PPACA) begins to sink it's ...

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It is hard to teach an old dog new tricks. No where is this more apparent than working to get physicians to understand the potential of social media for their practice.  The adoption of social media by doctors -- even something as relatively simple as Twitter, is tough. Face it:  Thinking that a re-tweeting of how much we want more doctors on Twitter by next year is just preaching to the social ...

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The field of medicine is one of the most rewarding occupations out there. Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did. Few occupations are allowed inside the most intimate and vulnerable moments of the human condition. In a word: amazing. But medicine for people has quickly given way to medicine for business. Business needs ...

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The Hippocratic Oath. Most medical students in America recite some version of this oath at their medical school graduation. Its text implies a sacred and overriding respect (ethic if you will) for the individual. Doctors are currently witnessing the profession of medicine moving from the ethic of the individual to the ethic of the collective. The passage of the Affordable Care Act has solidified this treatment ethic and, as a consequence, ...

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I know what you're thinking, punk. You're thinking "did he fire six shots or only five?" Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you've gotta ask yourself a question: "Do I feel lucky?" Well, do ya, punk? - Harry Callahan (played by Clint ...

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By now, the Obamacare insurance exchange debacle is old news. Our attention spans are so short, we're on to the next disaster.  So we sit before our TVs and enjoy the Humana ads with a smiling senior pointing to a whiteboards with their insurance plan name, or watch the news sponsored by UnitedHealthcare or Walmart's pharmacy department. Everyone's got a cheaper plan these days with more benefits than the other ...

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He looked ahead, seeing his feet on the hearth. There was smoke rising from one of the three logs, and he marveled at the small flicker of flame that stretched up and ignited the smoke that swirled above the log, dancing briefly somewhat joyously, then gone again, smoke returning. "You can't say you weren't warned," she said. He sat, reflecting on her words. So much years of work, so much effort, breadwinner, ...

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I continue to study for my third ABIM recertifications in both cardiovascular disease and cardiac electrophysiology. In preparation for the examinations, I purchased the review materials offered by the American College of Cardiology called ACCSAP-8 and took a surprisingly expensive cardiac electrophysiology board review course held in Chicago recently. I find I have little time to study all of this material while delivering patient care, so I've been getting up at 4:30-5:00am each day when ...

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A piece recently appeared in the New York Times entitled "Who Will Heal the Doctors?" The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called "The Healers Art," now being promoted in US medical schools that uses "mindfulness" as his means of creating compassionate, caring doctors as a way forward. I should say ...

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The great irony of health care reform is that really, nothing is new.  Everything, it seems, remains cloaked in secrecy. Yes, there are things called exchanges now.  And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law.  There will be counselors there to help people make an informed choice. But there's still a new complicated, unreadable law that promises much, but ...

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Three years ago, in the midst of all that was happening with health care reform, I thought about if I'd ever recommend medicine to my daughter.  I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned "The Top Ten Reasons to Be a Doctor."  It is, by far, the most popular post on my blog, having been ...

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Another seemingly harmless bureaucratic initiative aimed at physicians sunk its taproot deep in the daily workings of medicine recently. The Physician Payment Sunshine Act promises transparency in all industry dealings with physicians by shedding light on the issue of payments to physicians from pharmaceutical companies and medical device manufacturers. In turn, it will save the system money, since all those freebies bestowed upon physicians when the corporate world came knocking ...

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"It looks like you've done very well, Mr. Smith." "Thank you, doctor." He left the patient's room and ambled back to the nurses station, legs tired and ankles somewhat swollen.  It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day.  He sat down at the computer and logged in.  That's when he looked up briefly ...

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Sophie's Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp. While not of the same gravity,  I have seen the discussion by policy wonks about physician payment reform ...

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There is so much entropy in health care right now.  So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock.  Shock at prices, shock at waiting times, shock that doctors don't know how to increase referrals, shock that doctors aren't doing more to help.  What gives? In triage, you don't spend time with the expectant. Doctors are keeping their heads down.  They are still seeing patients.  They ...

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