It’s July and the newest doctors, interns, have continued their journey in becoming experienced doctors. These newly minted and graduated doctors have excitement, anxiety, and anticipation not unlike the first day of medical school, college, or high school. But as new doctors begin their next step, we rarely talk about those who also graduated. Specifically, doctors who have completed their residency and in some cases their advanced fellowship training. What about them? Certainly they have similar excitement, anxiety, and anticipation as they move on in their careers now as attending doctors. Unlike the past, however, this new part of their lives is less structured. There are no SATs, MCATs, or prerequisite classes to take. There are no applications to fill out. There is no checklist of things to do to get to the next part of training. In many ways, finishing residency or fellowship, aside from having a job, could […] Read More »
Category Archives: Other
Water for $1.50 or Soda for $1? Which would you choose to stay healthy?
Posted on June 20, 2013
Obesity is unfortunately too common in this country. The treatment of eating less and moving more should not be a mystery, yet the data shows that about 1/3 of patients are obese (a body mass index of 30 or higher) and another 1/3 are overweight (body mass index of 25 to 30). It is difficult to make healthier better choices when fast food restaurants, like McDonald’s, offer bottled water for $1.50 (plain bottled water) and soda, with its sweet sugary decadence, fizzy bubbles, and coloring for $1! They also give you a larger volume of soda compared to the water. In essence, individuals are paying more to be healthier! This does not make sense but is a unfortunate reality. The other challenge is that portion sizes are far larger than they were thirty years ago. A soda today is three times the size of a soda when I was growing […] Read More »
The Limits of Consumer Driven Health Care – A Trip to the Car Mechanic
Posted on June 4, 2013
As a practicing primary care doctor, I very much believe that better care is when patients are engaged and share decision making with their doctor. Though in the past doctors treated patients in a paternalistic manner, my generation of doctors has been taught to uphold a balanced doctor-patient relationship and partnership. This change in balance of power has accelerated with the ease and availability of information via the internet. More patients not only are asking about diagnoses and treatments, but correctly self-diagnosing. They merely come by to check in with me to make sure they got it right and to clarify the treatment options. Overall, this is better patient care. However, over the past few years a trend has gotten more momentum. As health care becomes increasingly unaffordable, many believe quality and costs would improve if we treated health care like other markets where consumers drive health care. If only […] Read More »
Physician Leaders I Admire – Bob Wachter, UCSF
Posted on May 16, 2013
Recently while following my twitter feed, I noticed the following from an associate editor from The Health Care Blog who quoted Dr. Lucian Leape, Harvard School of Public Health. Dr. Leape wondered why the patient safety movement hadn’t moved. He noted four reasons: Doctor resistance Doctors don’t do teams Difficult culture. No leadership. Though I did not attend the conference where Dr. Leape spoke, the answer seemed pretty obvious. To solve the problem you need leadership. It is leadership that defines the culture, whether teamwork is valued, and whether change occurs. The reason health care has not moved forward quickly enough simply because there has been a void of physician leadership across the entire health care system. There have been plenty of initiatives to improve patient safety over the past decade since the Institute of Medicine “To Err is Human: Building a Safer Health System“, but as stories demonstrate many of […] Read More »
David Goldhill Replies to My Post “Disappointing, Dangerous, Frightening” on His Interview on Healthcare
Posted on May 9, 2013
David Goldhill, CEO of the and author of the September 2009 Atlantic titled How American Health Care Killed My Father and book titled, Catastrophic Care – How American Health Care Killed My Father — and How We Can Fix It, recently responded to my post – Malcolm Gladwell and David Goldhill Interview on Health Care – Disappointing, Dangerous, Frightening His comments in his entirety: While I’m appreciative that you came to hear Malcolm and I discuss health care, you really don’t seem to understand much of what we were talking about. My work is an attempt to think about health care as an industry, and using comparisons to how other industries behave to understand why health care delivers such mixed performance — with extraordinarily high rates of error — at such high cost. My argument is a systemic one: bad industrial outcomes are a result of badly structured economic incentives; […] Read More »
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