Gaining prompt access to primary care is a growing concern for all American adults. In Massachusetts, average wait times for new patients to obtain an internal-medicine appointment rose by 82% in the 2 years after health insurance coverage was expanded; ...

The primary care doctor is a rapidly evolving species — and could become an endangered one. As we grapple with making health care more widely available and reducing its cost, it's hard to say how primary care physicians will fit into emerging delivery models.

In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.”¹ To identify unnecessary ...

Much progress has been made in applying scientific evidence to medical practice; less progress has been made in rendering care “patient-centered.” A five-step framework for reconciling the tension between “evidence-based” and “preference-based” medicine may help.

Hospital employment of registered nurses (RNs) increased dramatically during the recession, making it seem as if the decade-long national shortage of RNs had ended. But RN employment is countercyclical, and the bubble is likely to burst during the next several years.

Beginning in 2015, the Medical College Admission Test (MCAT) will include sections on behavioral and social sciences and critical analysis and reasoning. These revisions reflect the recognition that behavioral and social factors play major roles in health and illness.

HIV infection is now a chronic, treatable disease, and transmission is readily preventable. The Centers for Disease Control and Prevention recommend expanding HIV screening and eliminating unique requirements for informed consent, but not all states have done so.

Few factors influence health care standards in the United States today more than the actions of the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations). And few opportunities hold more promise for increasing the ...

What is the proper relation between a scientific understanding of disease and the subjective phenomenon of being sick? Between the subspecialist and the general physician? Between cure and care? “Patient-centered medicine” is the newest salvo in these debates.

An alternative approach to improving the quality of care — especially for patients with multiple conditions, severe disability, or short life expectancy — is to determine whether patients' individual health goals (e.g., for symptoms and functional status) are being met.

The most important attribute of patient-centered care is the active engagement of patients when fateful health care decisions must be made — when they arrive at a crossroads of medical options, where diverging paths have different and important consequences.

New ethics guidelines from the American College of Physicians calling for physicians to practice “parsimonious care” have reignited a debate about the role and responsibility of physicians in addressing problems with health care costs.

The relationship between patients and doctors is at the core of medical ethics, anchoring many important debates in the field. Over the past several decades, this relationship has evolved along three axes — as it is defined in clinical care, research, and society.

Precision medicine uses clinicopathological indexes and molecular profiling to create diagnostic, prognostic, and therapeutic strategies tailored to the patient. Its success depends on establishing frameworks for regulating, compiling, and interpreting key information.

U.S. parents who decline or delay selected vaccinations or refuse to vaccinate their children are a diverse group. Vaccine coverage can be increased by focusing on parents who encounter barriers to obtaining vaccines or hesitate because of fears about safety.

Whereas effective treatment for noncommunicable diseases may be too costly to disseminate globally, opioids for pain control are cheap to produce. Yet 80% of the population, including millions of patients with terminal cancer, lacks adequate access to pain treatment.

An Institute of Medicine committee has found that the magnitude of pain in the United States is vast — and costly. It concluded that relieving acute and chronic pain is a significant overlooked problem and that education is key to the cultural transformation required.

Troubled by the uncertainties in clinical practice, patients seek reassurance that doctors will work alongside them even in times of private doubt. How can we educate patients about what we know but avoid displaying hopelessness when we don't know?

Though life expectancy inexorably decreases with advancing age, we tend to avoid discussing overall prognosis with elderly patients who have no dominant terminal illness. But we may thereby undercut patients' ability to make informed choices about their future.

In the past 2 years, four major U.S. health care organizations have issued new guidelines on cervical-cancer screening. Although there are differences among them, all agree on some points, including that screening shouldn't begin before age 21 in immunocompetent women.