It used to be that doctors knew best. We told you what to do, and you obediently complied. The world has changed, and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected. The old way: “Well, I’ll be setting you up for surgery soon.” The new and improved way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks. Then, ...

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Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.” This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and ...

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178 measures. This is what we're up to -- the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions. Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive? That's a lot of questions all at once, and I'm not sure we're ...

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According to published reports, over 50 percent of doctors are burned out. The reason? They are overwhelmed by payment and quality rules as well as poor information technology. It’s no secret that physicians spend long hours seeing patients. But as financial pressures have mounted within hospitals, doctors are forced to perform more administrative tasks. In fact, administrative tasks account for nearly ...

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I often say that electronic health records (EHRs) is like Skynet in the Terminator. I expect to turn around from my screen someday, and Arnold will lift me by my throat saying, “You haff not been doing yuh meaningful use.” We practice in a time when EHR confounds us by freezing, crashing and chaining us continuously to our work, as we spend evenings and weekends on documentation. ...

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Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die.   We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza ...

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It was nearing the end of my day at the mobile health clinic where I work as a nurse practitioner, providing free, comprehensive primary care to uninsured patients in central Florida. Clinic was officially over, and we were no longer taking patients; I was signing notes and finishing up some teaching points with a PA student when a woman walked up and asked me if she could “talk to me ...

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You sign in, and there it is, your third request for your password just to open your electronic health record (EHR). “Again?” you think to yourself in frustration as your patient waits silently for you to log in and start the visit. It seems physicians are becoming increasingly frustrated with EHRs, and in most surveys, EHRs are noted as a main contributing factor to physician burnout. ...

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Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients. What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their ...

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For the month of September, I embarked on the experience of a lifetime, living and working on the largest Native American reservation in the United States. Sprawled across the four corners region of Utah, Arizona, New Mexico and Colorado, the Navajo Reservation in Chinle, Arizona, encompasses an area as large as the entire state of West Virginia. Its population, however, is only about 300,000, making it extremely rural. To leave ...

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