It’s a tale of two health systems: the VA and Kaiser Permanente. The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates. Kaiser Permanente ...

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According to a recent publication by the Robert Graham Center, the number of family physicians practicing high-volume obstetrics (more than 50 deliveries per year) dropped by over one-half from 2.3 percent of practicing family physicians in 2003 to 1.1 percent in 2016.1 In small corners of the country, though, innovative training programs continue to foster these skills among learners and build supportive communities for family ...

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Many years ago, on a busy day in my obstetrics and gynecology office, one of my partner's patients came in for "bleeding, early pregnancy." Since my partner wasn't in that day, I saw the woman, whose name was Sarah. After we'd talked a bit, I examined her and did an ultrasound. As I'd expected, she was having a miscarriage. Feeling sorry that Sarah had to hear it from me, rather ...

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There are a couple of times a year when there are no house staff to be found anywhere in the hospital or the outpatient practices. These include the holiday and end-of-year parties, resident retreats, and the annual house staff picnic. The house staff picnic is a particular favorite among the interns and residents, a full day away from the hospital, dressed like civilians, fun in the sun, barbecue, softball with their ...

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They come in all shapes and sizes. They are health care customers. The conveyor belt works relentlessly, and takes them to caring providers eagerly waiting for them. What is on the menu? Healing, understanding, human touch, reassurance, medical advice. All of that in a time efficient manner, in accordance with the sacred laws of productivity. It’s a miracle how top-notch care and productivity are ...

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The prevalence of burnout among physicians is estimated to be more than 50 percent and has grown in recent years. This alarming trend is largely due to changing patient demographics, increasing cost constraints, new federal and state regulations, and other external factors that have reshaped the daily work experience of physicians. Too often today, physicians spend more time on data entry than in direct patient care. Professional burnout, ...

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I walked into the ICU amidst a chaos of harried residents, chirping alarms, and the whir of the portable X-ray machine. Aromas ranging from old coffee down to vomit and stool mixed together in the usual fashion. In other words, it was a typical morning. I watched as my team gathered into a semicircle around me outside the first patient’s room and I got into my morning rounds stance: leaned ...

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Brooklyn, New York, Spring of 1992. As I looked out of the New York City taxi window on Avenue T, I saw the building. It had always appeared to me as the most magnificent building I had ever seen that housed people in need of rehabilitative care. I was happy; I was ready, I was in great spirit. “Let’s do this!,” I thought to myself as I stepped out of ...

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It’s no secret that the United States is in the midst of an opiate epidemic. Almost 60,000 people died last year from overdoses, and overdose deaths are now the most common killer of Americans under the age of 50. Physicians and our patients have finally started the difficult conversation about what it will take to stop the suffering. But what’s been missing from this conversation is that this is not ...

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“Aren’t you cute,” he said as he smiled and squeezed her cheeks. On the start of a new rotation, a medical student walked into clinic and introduced herself to the attending physician. With all of the news surrounding the Weinstein debacle, Alyssa Milano has urged women to share their stories of sexual harassment or abuse using the words “me too.” What has transpired is that a whole community of women from ...

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