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A Better Way to Train Family Physicians

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June 13, 2015

The Texas Academy of Family Physicians recently published a piece I wrote for them on the preliminary results of our P4 curricular innovations at my day job: the John Peter Smith Family Medicine residency. Briefly, the P4 project (Preparing the Personal Physician for Practice) was a national experiment where 14 family medicine residencies across...
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The Power of Comprehensive Family Medicine

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June 7, 2015

Hello again!  I haven’t written anything in a while. No big worries. I moved recently (same town, same neighborhood), but the remodel of the new house has been a mis-adventure and I’ve been living out of boxes and breathing dust for over a month. Things are kind of finally settling down. So back on...
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Overkill

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May 12, 2015

Atul Gawande, MD, who is the doctor-writer who has published frequently in the New Yorker and has published several well-regarded books, has written a great piece in the latest New Yorker. It’s called Overkill. It’s basic premise is that he went back to McAllen, TX to see how things were going 5 years after his...
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Diabetes and Other Screenings

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April 20, 2015

The best primary care-based research comes out of Europe, where countries have medical research budgets that actually fund primary care research. The U.S. has no equivalent funder. Therefore, American family physicians must often look overseas for answers to their daily clinical questions. Does screening for diabetes make any difference? A recent study funded by the...
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Fee for Service Brain Freeze

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April 1, 2015

A lot of healthcare system pundits including the current leadership of the American Academy of Family Physicians feels that fee-for-service payment is the root of all healthcare waste. Obviously, I disagree. Their line of thinking is based on the existing evidence that there are too many joint replacements, cardiac stents, cardiac tests, etc., because...
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A Different View on the Value of Statins

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March 25, 2015

Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much. For people who don’t like taking pills, what would a trade-off look like? If you were given the option of...
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Treating Hypertension is Nearly Useless

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March 8, 2015

A study was recently published in the New England Journal of Medicine about the cost-effectiveness of treating hypertension based on the most recent JNC 8 guidelines. This study particularly caught my eye, because previous cost-effectiveness analyses found that screening and treating for hypertension did not save money. The upfront costs of the doctors’ visits,...
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Heart Association Scare Tactics Revealed

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March 1, 2015

patients The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow this would result in a large increase in the number of Americans taking statins. One of the things I like about the new proposal is that there is no...
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More Exaggerations of the Benefits of Screening

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February 18, 2015

Recent news stories touted a 22% drop in cancer death rates that has “spared the lives” of over 1.5 million people over the past two decades. The American Cancer Society (ACS) was attributed as explaining this drop as caused by U.S. smoking habits, extra attention to cancer prevention, improvements in various cancer treatments, and...
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Harvard Professors are Beginning to Feel the True Cost of Healthcare

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February 2, 2015

I love opportunities for a good snarky belly laugh. I got one recently. A report in the New York Times by Robert Pear talks about how several key Harvard faculty have, for years, advocated for national healthcare reforms that turned into Obamacare. As a result (among many other issues that the U.S. refuses to...
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