Richard L. Neubauer

The Patient-Centered Medical Home: An Ethical Analysis of Principles and Practice

ABSTRACTThe patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient–physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

Internist Diagnosis and Management of Chronic Hepatitis B Virus Infection

Chronic infection with the hepatitis B virus can lead to hepatocellular carcinoma and cirrhosis in up to 25% of infected individuals. As many as 2 million individuals in the US may have chronic hepatitis B infection, most of whom immigrated to the US from hepatitis B-endemic regions of the world. A 2010 report from the Institute of Medicine noted that two thirds of patients with hepatitis B are unaware of their infection, and most health care providers do not screen for hepatitis B or know how to manage hepatitis B-positive patients. In 2010, the Hepatitis B Foundation convened a group of primary care providers to consider the existing evidenced-based recommendations and strategies for implementation of hepatitis B screening into routine practice. The group designed an easy-to-use algorithm for screening, initial evaluation, ongoing management, and referral to a subspecialist when appropriate. Internal medicine specialists, including primary care providers and subspecialists, need to understand the steps they can take to address this often under-recognized disorder.

Practice makes perfect...or does it?

Don’t worry about how long you think you ‘should’ practice. As you get better you will want to play more. All great guitarists have spent a lot of time perfecting their skills. Steve Vai, who is regarded as one of the most amazing guitarists of our time, has an “11 Hour Workout”. While I can’t say whether or not he practices 11 hours every day, I can tell you that he is a phenomenal guitarist who has spent years perfecting his techniques and continues to push himself even further. Eddie Van Halen is another rock legend who says he stayed in his room and practiced up to 10 hours a day as a teenager. While I don’t advocate wagging school, as he did, you can see my point, the more you practice the better you will become.