I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name. “Hey Dr. Young, I’m looking for some basic mentoring advice.  I’ve been moonlighting...
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It is so hard to push back against the influence of GIMeC, because people often make up their minds about reality based on stories of other people.  How many times have you seen this story on the TV news, magazines, or TV dramas? A person had some sort of pain or...
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The PCMH pushers love to talk about care coordination. They believe the key to more cost-effective care is to have primary care practices hire care coordinators to keep track of patients. I asked the leader of a large integrated network what his care coordinators actually do. He said they mostly track...
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The evidence continues to build on how little electronic medical records (EMRs) contribute to healthcare. A Cochrane review of on-screen computer reminders found that physicians’ practices (process measures, medication ordering, vaccinations, and test ordering) improved by 4% and patients’ surrogate health measures (blood pressure or cholesterol levels) improved by 3%. Another...
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Most chronic diseases don’t have an easily definable beginning point. Children’s personalities vary widely from quiet and focused to rambunctious and distractible. At what point do we say they have ADHD? There is an association between higher blood pressures and higher stroke and heart attack rates across a wide spectrum of...
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As the suits in the healthcare industry continue to try to change the healthcare system in their own MBA image, words such as targets and metrics are commonly used. A recent commentary from the BMJ reminds us of how sometimes when one process is improved another suffers. Patients want quick access...
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At the TAFP conference I attended last weekend, almost all the clinically oriented speakers showed data from their EMRs they felt proved they were providing high quality care. I’m sure their quality is excellent, but this won’t make healthcare more affordable. The measures most everyone showed included: how many diabetics had...
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One of my favorite parts in the journal BMJ is the occasional column written by Dr. Iona Heath, the president of the Royal College of General Practitioners. Her thoughts have helped me understand the similarities and differences between the U.S. and British physicians, healthcare systems, and culture. And I love her...
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One of the approaches some corporations are taking to hold down health care costs is to put more responsibility on their employees through high-deductible health insurance plans. It makes sense that they would try this. After all, this reflects the daily life of the business community as they compete for consumers...
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I received one of those politely worded letters from a major insurance company recently informing me of how it thought I was doing caring for one of my patients. It includes warm language such as “We value our relationship with you,” though their medical director who signed this letter has never...
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