Jeffrey H. Millstein, MD
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Latest articles
Physician voices
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work…
I am in the exam room, leaning forward hearing my elderly patient describe weeks of worsening fatigue. Her daughter fills the gaps as her mother, hard of hearing and anxious, struggles to find the right words. Her recent lab work shows a steep drop in her blood count. We are working together to understand what is going on. As I prepare to enter orders in the electronic health record (EHR), …
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The hidden clinical cost of HCC coding in primary care
Health technology
Clinical decision support tools in the EHR are gaining momentum. These exciting and meaningful innovations are challenging us to make room for them to flourish. New technology is often disruptive before it finds its way to being helpful. In the…
Clinical decision support tools in the EHR are gaining momentum. These exciting and meaningful innovations are challenging us to make room for them to flourish.
New technology is often disruptive before it finds its way to being helpful. In the late 1800s, the telephone created unexpected challenges in medical practice at its inception; it brought a need for new team members to answer calls and required doctors and patients to develop …
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New primary care decision support tools make offloading below-license tasks from the EHR more important than ever
Physician voices
For some, it may seem strange to think of the doctor-patient interaction as a relationship. In the most basic sense, a relationship is a connection; it is how two or more people or groups regard and behave toward each other.…
For some, it may seem strange to think of the doctor-patient interaction as a relationship. In the most basic sense, a relationship is a connection; it is how two or more people or groups regard and behave toward each other. Relationships are not static – they are influenced by an ever-changing social, cultural, and political environment. They must try to adapt or risk tension and strife; the doctor-patient relationship is …
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Resetting the doctor-patient relationship: Navigating the challenges of modern primary care
Physician voices
I am recalling a workshop on unconscious bias from last year, the moderator hands outpatient prototype profiles to each table of participants. Ours is a glossy paper with a color photo of our patient, Jane, and a clear outline of…
I am recalling a workshop on unconscious bias from last year, the moderator hands outpatient prototype profiles to each table of participants. Ours is a glossy paper with a color photo of our patient, Jane, and a clear outline of her type of employment, hobbies, interests, family members, religious beliefs, and how she prefers to receive information. This strikes me as very clear and succinct, calling attention to many of …
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Thorough documentation can be weak representation of patients
Physician voices
Last year, my high school aged son took an interest in healthy eating. He began examining nutrition labels and scrutinizing the foods that we routinely keep around the house and came up with a list of criticisms and suggestions --…
Last year, my high school aged son took an interest in healthy eating. He began examining nutrition labels and scrutinizing the foods that we routinely keep around the house and came up with a list of criticisms and suggestions — some well-founded, and others a bit extreme. At first, my wife and I were quick to debate him on certain choices like eliminating any breakfast cereal that has enough sugar …
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What parenting has taught me about doctoring
Physician voices
It wasn’t long into my clinical training when I realized that most patients do not convey information the way templates are designed to record it. Instead, they tell stories -- which may weave from topic to topic, progress forward or…
It wasn’t long into my clinical training when I realized that most patients do not convey information the way templates are designed to record it.
Instead, they tell stories — which may weave from topic to topic, progress forward or backward in time or in patterns that may not be familiar or clear.
But they are told as the patient sees fit to convey them. David, a forty-year-old man who recently presented …
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It is time to reframe patients’ medical history?
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