As people select health insurance during open enrollment, what many don’t realize is how the creation of the health insurance exchanges or health insurance marketplace via the Affordable Care Act (a.k.a. Obamacare) will ultimately result in Americans becoming less healthy and more insolvent. Let’s review the pros and cons.
Although the Affordable Care Act provided important benefits of expanding and ensuring coverage with preventive benefits, insurability of all regardless of prior …
My journey in the specialty of family medicine started in 2004 during my third year family medicine clerkship. I was assigned to an office located in the southwestern town of Yauco, Puerto Rico. The practice had two providers who saw patients of all ages. My family medicine attendings made me appreciate the way our specialty approaches patient care. We treat our patients taking into account their psychosocial framework and partner …
A version of column was published in USA Today on September 14, 2014.
The public can rate and review most things today: books, hotels, and restaurants, to name a few. Even doctors. There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much …
There is abundant evidence for malaise in the physician workforce, but little agreement about etiology, treatment options, or prognosis. As a senior physician who still has a lot of involvement with physicians of all ages, I want to propose an etiologic framework. Perhaps if we agree on etiology, we can look at treatment options.
There are three ways to look at what doctors do: the artisanal, the economic, and the scientific. The …
I thought more highly of business folks until I started working for them. I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc. Once the vision was elucidated, everyone worked together like a team to make it happen.
For those of you who have been riding along with me on my journey for the past few years, you know that it has been one heck of a ride. What started out as a little blog to encourage other doctors who were struggling with burnout has exploded. In a good way.
My blog came about because I was looking for a way …
I have been a victim of diagnostic overshadowing by a primary care physician. I’ve been dealing with major depressive disorder, recurrent, severe and anorexia for twenty-five years — practically my entire adult life. However, I work full-time and I’m a published writer. At the time I saw this PCP, I was on hefty doses of Cymbalta (an antidepressant) and Abilify (an antipsychotic which can also be used to boost the effects of an …
The days of using your insurance to see the family doctor are numbered.
As more patients join the practice and I hear each new patient’s story, I become more impressed with the benefits of direct primary care for both the patient and the physician.
Recently, a 63-year-old female, who we’ll call Martha, came in for a visit. Martha is an out of work chef who, due to financial hardship, hasn’t had health …
Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists.
From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s …
Years later, I now wonder if I overstepped my boundaries.
Nancy was a pleasure to have as a patient. A physician assistant in her early twenties, we often chatted amiably during visits. Our conversations randomly ambled between personal and professional topics. She recently married and was looking forward to having children. Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a …
Just yesterday I was searching for a local surgeon, and on one website he had 2 out of 5 stars. Hardly anyone was recommending him. Yet prominently featured on another site he had 4.7 out of 5 stars. Both sites had a good number of reviews. What’s going on? Is one site cherry picking the reviews? Is someone falsifying reviews on one of the sites? Which reviews can I trust? …
After reading a book about conducting good business, you’ll likely review the concept of adequately meeting demands for clients or consumers. Whether a company is thriving due to lower pricing or higher quality, in the world of business, the golden rule is provide value or go bankrupt.
One industry has seemingly remained immune from this concept, however. In the past few decades, especially, health care has unequivocally failed in …
As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic …
One of the major reasons that health care providers resist implementing an electronic medical record (EMR) system is the belief that using it will decrease provider productivity, reducing the number of patients they can see and therefore reducing practice revenue.
However, an EMR that is designed around a streamlined workflow can enable providers to work faster and more efficiently. Having an EHR and vendor that can give you ongoing visibility and …
Fans of Star Trek: The Next Generation will recall that the most disturbing aliens encountered by the Federation were the Borg, a part-cyber, part human collective race that functioned as an integrated and cyber-connected whole that existed only for the good of the collective, rather than as distinct individuals with their own thoughts and personalities — much like honey bees work together as …
Ruth was problematic. Well into her seventies, her body may have dulled but her tongue was sharper than ever. And she used it to lash me with complaint after complaint. If it wasn’t her knees, it was her ankles. If it wasn’t her ankles, it was her hips. I battled the impossible month after month, year after year. Our interactions left a bitter taste in my mouth. Nothing makes a …
Recently, my eldest son came home from college for a couple of days. Our home was in perfect harmony and rhythm. The duets (and quartets, if you count us parents) that had played over the prior month-and-a-half were once again trios and quintets. Five or six hands on the piano at a time. The clear brass joining in again with the bright woodwind and the deep bass. The voices in …
I believe we choose our parents before we are born. I hit the jackpot.
I picked an unlikely pair — a radical feminist and a guy named Ted Krouse. Mom wasn’t home much (she was finishing up her psychiatry residency) so I became head of the household. Dad always kowtowed to the strongest woman in the room. I was two at the …
Many physicians are discouraged by the state of medical practice in 2014. Maintaining job satisfaction and well-being for the duration of a decades-long medical career can be as daunting as completing an uphill marathon. In addition to keeping up with the explosion of medical knowledge and maintaining certification in your specialty, what concrete practices can you adopt to insure that you will make it to the finish line in good …
