A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock. This “system” often doesn’t work, because of the way medical specialties are divided up. If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the ...

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It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam. She and her husband were about to try to have their ...

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Well, I won. Six years after I started down the very slow process to end forced MOC in my state, it happened. On December 27, 2018 Michigan governor Rick Snyder signed HB 4134 and 4135 into law. The harm BCBS caused me and my patients will never happen to another pediatrician in Michigan. I know. Crazy. I'm still in shock. It's taken a while to process it enough to ...

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When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history. Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how ...

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Some people think that the solution to better-supported primary care is in direct primary care/salaried physician payment models. I don’t think it is the best answer. I realize money is not the only motivator explaining why people perform work. Meaningful work matters too. But meaningful work that is not respected and paid for will not sustain or be the source of burnout and resignation, not only for physicians.  I think ...

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Just the other day, while I was in the middle of seeing a morning schedule full of patients, I opened one patient's chart and was thrilled to see a whole bunch of new icons in Chart Review in the electronic health record that I had never seen before. These apparently indicate office visits and other health care encounters with outside providers. Sometime during ...

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It was an ordinary afternoon in my outpatient internal medicine rotation. I prepared to enter a room for a congestive heart failure hospital follow-up patient. I mentally prepared myself. I was going to ask for his hospital records (particularly looking for the echocardiogram), make sure he was started on an ACE inhibitor and a beta-blocker, and ensure he had a follow up with a cardiologist in the coming weeks. “This ...

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"I have the CPAP machine. I've had it for a year, but I don't have electricity in my house. I stayed with my aunt who has electricity but things didn't work out," said the young Navajo man, his massive belly protruding out from underneath the tray table. The old Navajo man with Parkinson's disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal ...

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"Are you the doctor?" was the most frequently asked question I received from patients in my new practice. The second most common question was: "Are you old enough to be a doctor?" followed by the rather blunt question "How old are you?" I graduated from family practice (FP) residency in 2002 when I was 26-years-old — younger than most newly minted FP doctors. This warrants some explanation. I didn't skip several years ...

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When I was a kid, one of my favorite hobbies was adding to my rock collection. In the summer, I went on road trips with my family to explore the national parks, and at every gift shop, I always gravitated towards the bin of tumbled stones. To me, this was a treasure trove. I looked at all of the stones and was mesmerized by their vibrant colors — from emerald ...

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