I envision the point of nurse practitioners and physician assistants is to handle the routine and allow doctors to spend their intellectual capital on these harder, more complex cases. Sorry to hear that’s not the case
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Great article and so true. I routinely have new patients who come with reams of past reports of scopes, scans, and labs. There simply is no time. I leave open a half day per week for “panel management” (on my dime of course). It’s still not enough time to think.
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Time to change the model. Outpatient medicine is increasingly complex. Fee-for-service never served patients nor cognitive specialists well. Redesigning care is possible and may be our professional responsibility.
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This is a beautifully clear description of
#moralinjury. We desperately want to do better for patients, and we know how, but competing expectations and distractions preclude our action.Hvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi
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God help me if the urological history requires reviewing past studies of MRI/CT's, the various treatments in a disease that already lasts for 5-10 years, or assessing social determinants (what economic income he has, how much help in dependence).If it requires thinking, I'm sunk.
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Very humbly written, and very true. Thanks for sharing.
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thanks for sharing and thanks to rise a discussion where I realize that many doctors have a similar problem to mine. unfortunately for patients!! it is time to look for a different way to manage empathy, competence and clinical resarch
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Just read
@nejm piece Perchance to Think. Sooo many points about being a#primarycare doc that are made beautifully. I sincerely hope the right
read it; while it's cathartic/validating for docs to read it, I'm not necessarily referring 2docs when I say 'the right eyes'. 
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Such a great article. Thanks for writing and sharing it
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Great article. Do you think things will change with the focus on value based purchasing and/or the move away from pay-for-performance and toward outcomes?
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