Whether by design or by necessity, it appears that single payer is inevitable. Economic reality demands it. Some external force needs to be applied to counter the cost of rapidly expanding medical technology coupled with the political and legal pressure to make that technology available to as many people as possible, regardless of their ability to pay. The problem is certainly not new, but we are at the point of having ...

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Over the past several years there have been numerous reports on the rates of death and injury in children with firearms.  In fact, a 2-year-old child recently accidentally took his own life in Philadelphia recently.  Although the studies don’t entirely agree, two things are certain; 1 death is one too many and children don’t need to exercise their second amendment rights. The United States has by far the highest rate of ...

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I’m passionate about patient safety. In no small part because I was raised to be. My mom has a lot of letters behind her name (RN, BSN, MSN), and she’s dedicated her career to the field. Before I was accepted into medical school, I knew about "six sigma," the "Swiss cheese model" and root-cause analysis. I’d been taught about creating a culture of safety and the example of the airline industry. ...

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Following a relatively routine doctor appointment, I received my bill for over $1,000. I rubbed my eyes, hoping to find an overlooked decimal point. I didn’t. My experience is not unique. We have a problem in the U.S. We pay over $3 trillion annually for health care — about 18 percent of our GDP. No other developed nation spends more than Read more...

This open enrollment season, patients will be considering their health care coverage for the coming year. To ensure they are fully utilizing their primary care benefits and building relationships with health care teams that will keep them healthy, we need to encourage them to connect with a primary care practice or medical home. A medical home is a place where a patient can seek treatment from primary care physicians and other ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. As part of my role in International Programs at the American College of Physicians (ACP), I have a unique opportunity to travel frequently and engage with internists around the world. In fact, I am writing this while almost 7,000 miles away from home, ...

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Periodically we should reflect on what challenges face patients and physicians.  Over the past few days, I have worked on a list of the issues that concern me the most.  I welcome suggestions for expanding the list. 1. Diagnostic errors. All patient care requires that we make the proper diagnosis.  Too often we make errors.  A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis.  A similar ...

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How important is it for a doctor to want to be a doctor? At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn't want to. Right? First, there's the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that ...

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October is the epitome of academic conference season. Returning home, suitcase laden, and a belt-hole wider from lost promises of exercise, and plans to “watch what I eat” while on the road, I am ready to get back into my routine. All the same, I come back refreshed by a new flavor to the mundane routine of conference experiences past. At the three conferences that I attended this fall, women ...

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A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared. This article, part two of a series that began with a look at primary care disruption, examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, health care’s rising cost issues. According ...

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