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Relational Medicine: The Joy Of Primary Care

I was happy when I looked at [the day’s] schedule. Two husband-and-wife pairs were on my schedule, both of whom have been seeing me for over 10 years. Their visits are comfortable for me — we talk about life and they are genuinely interested in how my family is doing. They remember that I have a son in college, and want to know how my blog and podcast are doing. I can tell that they not only like me as a doctor — they see me, to some degree, as a friend.

Another patient on the schedule is a woman from South America. She has also been seeing me for over 10 years. I helped her through her husband’s sudden death in an accident. She brings me gifts whenever she goes on her trips, and also brings very tasteful gifts for my wife. Today she brought me a Panama hat.

I know these people well. I know about their past illnesses and those of their children. I know about their grandchildren, having hospitalized one of them over the past year for an infection. I know about the trauma in their lives as well as what they take joy in. They tell me about their trips and tell me their opinions about the healthcare reform bill.

I spend a large part of their visits being social. I can do this because I know their medical situation so well. I am their doctor and have an immediate grasp of the context of any new problems in a way that nobody else can. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Is A Nurse Practitioner A “Doctor?”

Nurse practitioners are demanding a wider scope of practice and even to be called “doctor” if they have a doctorate. And 28 states are considering giving them what they want, to which physician societies object.

Health policy analyst Jack Needleman (a Ph.D., so he gets to be called doctor, too), says the quality of care is the same. (He’s also an honorary fellow of the American Academy of Nursing.) AMA president-elect and internist Cecil B. Wilson, M.D., a Master of the American College of Physicians, (who is definitely called doctor) says the primary care shortage is a call for more physicians, not for fewer. Read more »

*This blog post was originally published at ACP Internist*

Summer Comic Relief -Or- You Can’t Take Me Anywhere…

Well, it’s a summer Saturday on the blog – which means that the Better Health editorial standards are a little more lax. And this week I’m willing to share some highly embarrassing personal details for your amusement.

Over the course of my lifetime, my exposure to baseball has been somewhat limited. In fact, the only games I ever went to were at the demand of an old grad school roommate who had a crush on José Conseco. We lived in Dallas at the time and she forced me to accompany her to the games so that at the end she could stand by the exit gate and catch a glimpse of him as he left the ballpark.

As a long-suffering and supportive friend I endured countless games in the Texas summer heat – sitting in the nosebleeds at Ranger stadium, with no more than a folding seat, napkins to wipe my brow, and a long line to a dirty bathroom. Apparently Nolan Ryan was an amazing pitcher – but it was hard to tell from such a distance.

So that was pretty much the sum total of my experience with baseball, and the reason why I hadn’t been all that interested in taking friends up on more recent invitations to go to a ball game. But yesterday my world changed.

My dear friends Heather and Doug (aka Mr. Heather) convinced me to join them at Nationals stadium yesterday… and I was astonished by the creature comforts of the place. Open air sports bars, restaurants, game tents, air conditioned box seats… food buffets. My goodness. This was not at all what I remembered about baseball – and we got to sit just above home plate.

Now, the only problem was that I really never learned the more complicated rules of the game – like why can the guy on third run home after the outfielder just caught the batter’s ball and he’s out? I know I’m the only person in the world who doesn’t get it, but that’s ok.

The real problem came when I was en route to the game and experienced some brand confusion. I noticed everyone wearing these red hats (on the right below) and I knew that our team was called “The Nats” so… I just didn’t make the association between the W and our team. And quite frankly, the font looks an awful lot like Walgreens doesn’t it?

walgreensYeah, so I did accidentally let slip my confusion about all the “Walgreens hats.” I thought maybe they were a big team sponsor or something.

My friends were at first confused, then horrified, then laughing uncontrollably. I kept protesting that it was an honest mistake (given the branding similarities), and they said, “Oh yeah, like TOTALLY” and did their best blonde Valley Girl impressions.

The other problem was that although I knew the hand movements made when the umpire wanted to indicate that a player was “safe” on base, I didn’t recall that the opposite resulted in a movement very similar to what I do when I’m really psyched about a victory of some sort and say “Yes!” You know, you make a fist with bent arm and bring it quickly down to mid abdomen from shoulder height.

So, in all truth, there was a moment of confusion in my mind when I saw the umpire making the “Yes!” movement – it seemed kind of partisan to me, and I wondered why he didn’t just make the “safe” sign. And then the runner walked away all dejected. I should have kept my mouth shut and let me brain process, but I let it slip to Heather – why does that umpire guy go “Yes!” all the time?

We had a good laugh… some amazing nachos… and our team won 7-6 so it was a really exciting game all the way through. I told Heather the stadium was so nice I’d be happy going there just to hang out – game or not.

Kudos to the Washington Nationals marketing team – even with our team being in last place, the experience was outstanding – causing even a hardened baseball skeptic to rethink her position on game attendance. Now if you could just do something about the Walgreens logo… 😉

Why Giving Free Care To The Uninsured Is Good Business

Walgreens made some headlines with their program to give free acute care services to those who are unemployed.

Before you think that they’re doing this out of the goodness of their hearts,

Doctors rarely would drop patients who have recently gone on Medicaid, or worse, lost their health insurance altogether. Why? As Dr. Sidorov writes, “Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured.”

Walgreens is applying the same principle. Today’s uninsured patients will, more likely that not, have insurance in the future, and will repay Walgreens back for helping them out during these tough times.

So, rather than patting Walgreens on the back for their kindness, you should be noting their business shrewdness instead.

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Latest Book Reviews

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

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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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