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Finding and keeping great front office staff

Physician

July 13, 2013

Your front office staff are the face of your practice — an expression of your practice’s philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists.

But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low …

MKSAP: 38-year-old woman with fatigue and dyspnea on exertion

mksap

Conditions and Diseases

July 13, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), …

MKSAP: 26-year-old man with fever and lower abdominal pain

mksap

Conditions and Diseases

July 13, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 26-year-old man is evaluated for a 3-day history of fever, lower abdominal pain, tenesmus, hematochezia, and watery diarrhea. Seven months ago, he underwent a cadaveric kidney transplantation. At the time of transplantation, the transplant donor was seropositive for cytomegalovirus, and the patient was seronegative for this virus. Current medications are tacrolimus, mycophenolate …

Not everyone who has an opinion on nutrition is an expert

David L. Katz, MD

Physician

July 12, 2013

Everyone has opinions. You probably know what they say about that. But leaving aside the olfactory qualities of all the opinions to which we are entitled, we at least tend to know when our opinions are just opinions. But not with nutrition, where not only does everyone have an opinion, but everyone seems to think theirs is an expert opinion. And our culture seems to be okay with that. I’m …

Should drug testing be considered screening tests?

Chris Rangel, MD

Conditions and Diseases

July 12, 2013

cropped-clean_urine

Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …

Health care price transparency should receive bipartisan support

Bob Doherty

Health Policy

July 12, 2013

Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …

I need to take my role as historian very seriously

Bruce Campbell, MD

Physician

July 12, 2013

Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness.
-Simon Schama

“Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?”

“It wasn’t a surgery,” He tells me emphatically. “It was a biopsy.”

“But the doctor SAID it was a surgery!” chimes in his wife.

“Yes, Dad. You have a long scar on your neck,” adds his …

How can we fix the doctor-patient relationship?

Rob Lamberts, MD

Physician

July 12, 2013

A post I wrote nearly three years ago has recently gone viral, bringing tens of thousands of readers and a huge number of comments. It’s a letter I wrote to my patients who do something that all but guarantees a bad relationship with many (if not most) physicians: they don’t get better.

There are basically two responses I get to this post: either readers are grateful to have a doctor admit …

Is your hospital leader committed to patient-centered care?

Robbin Dick, MD

Health Policy

July 11, 2013

Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to its last dying breath that they have any priorities that supercede patient care, nearly all do.

They usually go like this: first priority is high margin surgical cases; second priority is …

Primary care doctors need 35 hour work weeks

Leslie Kernisan, MD, MPH

Physician

July 11, 2013

Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …

Medical writing: Tips to avoid burnout when starting out

Brian J. Secemsky, MD

Physician

July 11, 2013

Last month marked the first anniversary of two very important milestones in my career in medicine: I began training as a physician and started writing about medicine. Although perhaps not equally as demanding, both of these new activities in my life required overcoming steep learning curves and involved constant self-reflection and personal change.

Writing medical humanities pieces for different media outlets has been and continues to be a source of personal …

True pain and suffering: There is no place for manipulation

Greg Smith, MD

Physician

July 11, 2013

“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.”

“If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.”

“I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.”

I hate to be manipulated.

Hate. It.

There is a certain …

3 secrets my doctor doesn’t know

Danea Horn

Patient

July 11, 2013

Dear Doctor,

I am a good patient. I’m organized, I know my health history and I’m particularly polite. I’ll thank you just for giving me bad news.

I look up to you. I do see myself as a partner in my care, but I depend on your expertise. I appreciate the years of schooling and sleepless residency nights that have trained you to know what might be causing my pain and how …

Read more…

3 secrets my doctor doesn’t know

American’s health cost problem has no easy fixes

Kevin R. Campbell, MD

Health Policy

July 11, 2013

It is clear that healthcare in the US is more costly than in any other place in the world. We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount. How did we get here and what are we to do about it?

Recently, an article appeared in the Read more…

American’s health cost problem has no easy fixes

Physicians need to speak with a unified voice

Jordan Grumet, MD

Health Policy

July 10, 2013

Many ask of our profession, “Are you knight or knave?”

The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.

The time for change has come.

After patiently listening to my …

Firing your doctor carries emotional weight

Jessie Gruman, PhD

Patient

July 10, 2013

Last week, a friend told me that her mother had been fired as a patient by her primary care physician in a letter she received in the mail. “Our philosophies of care are too different,” was the explanation.

Last week, I fired my oncologist by email. “I have transferred my care to ___ ___.” I gave no explanation, although the note was polite and appreciative.

My friend and I spent some time …

How should the workplace accommodate women physicians?

Linda Brodsky, MD

Physician

July 10, 2013

A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …

How teamwork can help improve primary care access

David Margolius, MD

Physician

July 10, 2013

In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor’s appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often dozens of patients call for a limited number of appointments. …

As residency begins, always remember there is hope in medicine

Kyle Bradford Jones, MD

Medical Education

July 10, 2013

Nearly twelve years ago, Major League Baseball’s Cleveland Indians were losing to the Seattle Mariners 14-2 in the 6th inning. Cleveland, who were fighting off the resurgent Minnesota Twins and the pesky Chicago White Sox in a tight division race, were playing against a Mariners team that would finish the season tied for the most wins ever in a single season. Despite the seemingly insurmountable lead, Cleveland came back to win …

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