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The Reality Of Participatory Primary Care

No matter where one stands on appropriateness and advantages of each patient being involved in self-diagnosis and treatment of their own medical problems there are two inevitable conclusions:

•    First of all, self diagnosis and treatment are as natural as breathing and as impossible to extinguish as thought itself.

•    Secondly, given today’s healthcare system, there always will exist a dynamic tension between self-determination of the individual patient and the powerful healthcare system which often insists on patients falling back in line and complying with orders.

Few would argue against the need for a powerful alliance that embraces the benefits brought to the table by both the practitioner and the patient. Simplistically, the physician would carry the role of healthcare consultant and guidance while the patient ultimately becomes responsible for the choices. Read more »

Integrating Wellness Into A Primary Care Practice

I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous.

To those who want to know more about wellness and primary care, here’s my approach:

• I never try to sell anyone on a “wellness” program.
• I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee.
• I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin and nutrient therapies or colonics, to name a few). 
• I try to be as cost effective as possible when it comes to treatment.
• I see our patients once a year to comply with the legal definition of “face-to-face visits,” but not because scientific evidence substantiates this time honored ritual as “wellness.”
• I use calendar reminders in our electronic health record, MD-HQ to set up needed labs like cholesterol or Hgba1C or to schedule flu shots based on guidelines.

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How I, A Doctor, Came To Build An EMR

My desire for integrating the power of technology with primary care started nearly two decades ago. It was then, when working as a family physician in a busy medical practice, that I began experimenting with typing my notes and using computers in front of my patients.

In 2001, I launched a new medical practice DocTalker, focusing on access of medical care to patients, and almost immediately I started searching in earnest for an EMR solution to fit my needs. However, I was not happy with the systems I looked into and tested and felt that they didn’t do what I needed them to. 

Some of my discontent came from the way my medical practice consults with patients, which is primarily via telephones and emails and house calls (in addition to the common office visit). Because of our ability to offer telemedicine, we often treat patients when they’re not  in town, but rather traveling for business or taking a vacation. We therefore must interface with hundreds of different local labs, radiology groups, pharmacies, and specialists. Read more »

Doctors Wanted For Hazardous Journey


With this want ad, circa 1914, Sir Ernest Shackleton recruited 28 souls with an unimaginable challenge: To cross the unexplored Antarctica on dogsled. The polar explorer knew exactly what human characteristics he needed to pull off such a feat and understood that straight talk would resonate with a few select men.

Shakleton and his crew boarded their ship, the “Endurance,” and sailed the world’s most dangerous oceans straight into harms way — still considered one of the world’s greatest survival stories. Amazingly, all men survived against unimaginable odds. Their story reminds us that we all stand on the waves and wakes of dreamers, doers, slaves, and fools, all who say, “We did it, took our chances, immigrated to the U.S., headed West, built a new business, risked it all.”

And, if you listen closely, you will hear their stories as an invitation that has been repeated throughout history: “What will you do? Whether your turn or your calling, what will you do?”

Today, I’m posting a similar want ad to medical colleagues. The journey may be far less physically dangerous, but considering prevailing attitudes, perhaps it’s as daring in imagination. Read more »

Leaving The Organization But Not The Practice Of Medicine

I confess ignorance. I know nothing about interviews with vampires. However, last week on my drive to a house call to see a sick patient, I experienced a sudden respect for author Anne Rice. I listened to a stranger completely off my radar screen being interviewed on NPR saying and making me feel the meaning of the phrase “Evil needs but one thing to grow. It is for good people to do nothing,” and reminding me that throughout history there have been numerous times where groups, organizations, and governments have acted even in ways that don’t represent our values or feel wrong minded or appear short sighted.

This statement was her simple explanation for a recent blog posting announcing she was resigning from Christianity. She remained a believer in God and in Christ, but no longer would listen to the Church tell her what to think, when and how to believe, or define truth while trying to control belief and the process. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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