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Emergency physicians who love their guns

Edwin Leap, MD

Physician

November 1, 2012

When I was a resident physician, I had the coolest classmates ever. We worked together, laughed together, learned together and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer.

But one of the things that united us, one …

The only religion that my patients see me practice is medicine

Jennifer Gunter, MD

Physician

November 1, 2012

When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.

So I spoke with her. I explained that over the course of her career she would undoubtedly see people from …

There is more to life than avoiding death

Christopher Johnson, MD

Physician

October 31, 2012

There is a broad consensus among healthcare policy wonks that the 800 pound gorilla in the healthcare cost debate is that a big chunk of the medical care we provide — some say as much as a third — does not help. It may even make things worse for patients. Aside from the ethical issue of doing things that don’t help, and may hurt, this useless and dangerous care is …

Fixing Medicare: Both providers and patients need skin in the game

Manoj Jain, MD, MPH

Health Policy

October 31, 2012

As I approach my 50th birthday, I worry about Medicare not being there for me when I become eligible. I have some inside knowledge about Medicare. My parents and in-laws are patients on Medicare. As a doctor, I am a provider for Medicare, and as a public health educator I am a consultant for a Medicare quality improvement organization.

Everyone, including the leaders of both Democratic and Republican parties, agrees that …

Performing surgery is not about empathy

Jeffrey Parks, MD

Physician

October 31, 2012

The Surgeon had been handicapped by a burr in the plantar aspect of his left foot. All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning. There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp …

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Performing surgery is not about empathy

Stop penalizing doctors for effectively using EHRs

Margalit Gur-Arie

Health Technology

October 31, 2012

The health care crowd is abuzz with the New York Times revelation that Medicare billing rates seem to have increased by billions of dollars in parallel with increased adoption of EHR technologies for both hospitals and ambulatory services. The culprit for this unexpected increase is the measly E&M code.

Evaluation and Management (E&M) is the portion of a medical visit where the doctor listens to your description of …

Doctors who manage patients in the office aren’t the problem

John Mandrola, MD

Health Policy

October 31, 2012

I am riled up—almost to the point of being inflamed.

I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team.

The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30.

When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it …

Why health care is a civil right

Duncan Cross

Patient

October 31, 2012

I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.

Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For …

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Why health care is a civil right

Moving death certificates to the digital age: Unintended consequences

Edward Pullen, MD

Physician

October 30, 2012

Moving from paper death certificates to an online process called the Washington State Electronic Death Registry System, or EDRS. Sounds like a simple 21st century process that should make the process of completing a death certificate faster and easier right? Oh, the government designed the system. Oops.

I’ve been so frustrated by the unintended consequences of a new state governmental process for completing death certificates.

Beginning in early 2012 Washington state started …

There is no right way to help infants sleep through the night

Wendy Sue Swanson, MD

Physician

October 30, 2012

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.

There are many things that go into the equation …

Is a lapse of memory a sign of Alzheimer’s?

Suzanne Koven, MD

Conditions and Diseases

October 30, 2012

I was making a mental packing list for a fall weekend at the beach: sweatshirt, jeans, sunglasses, those sandal things–you know, for walking on rocky shoreline? Kind of ugly, but useful? I could picture them clearly–the rubber soles and webbed uppers–but their name escaped me entirely. A person’s name, maybe? I started to go through the alphabet letter by letter, hoping for a clue. But it was gone. Not “wait, …

Why I made the change to direct care practice

Rob Lamberts, MD

Physician

October 30, 2012

Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships. I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.

For some, this transition will be more hassle than anything. Some people …

Strive to maintain our compassion for others

Alex Lickerman, MD

Physician

October 30, 2012

I vividly remember the first day my medical school classmates and I met our cadavers in the anatomy lab. Large body bags lay on metal tables that had been bolted to the floor. I remember the sheer size of the bags best. No doubt existed in my mind that dead human bodies indeed lay within them. And yet part of me couldn’t quite grasp that I was actually going to …

Patients and doctors interpret fee for service differently

Bob Doherty

Health Policy

October 29, 2012

The debate over fee-for-service physician payment often is misunderstood to be about the technicalities and relative merits of the RUC, relative value units, P4P and the SGR. It isn’t—instead, it’s what the fee itself represents (and who decides), and what the service being provided actually is (and how it’s described).

Let me explain. Analysts across the political spectrum agree that the health care system needs to move …

Having patient satisfaction data isn’t enough to choose a hospital

Trudy Lieberman

Patient

October 29, 2012

When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I discovered, I wondered if perhaps a few measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients …

Why medical students need to begin in the classroom

Lucy Hornstein, MD

Medical Education

October 29, 2012

My esteemed colleague Dr. Bob Centor is enamored of an interesting essay from which he quotes:”Only you can educate you—and you can’t do it by memorizing. You have to find out who you are by experience and by risk-taking, then pursue your own nature intensely. School routines are set up to discourage you from self-discovery. People who know who they are make trouble for schools.”

Personally, I found it more of …

Help your doctor understand where you’re coming from

Peter Ubel, MD

Physician

October 29, 2012

Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.

I learned about Scott while reading Jon Ronson’s …

The rewards of family practice in a rural town

Haley Adams

Medical Education

October 28, 2012

Although McAlester, Oklahoma, is a relatively small, rural town, it’s the largest town in southeastern Oklahoma. Well over 100,000 people come through for a number of goods and services, including health care. Growing up 30 minutes outside of town, I understood rural Oklahoma from a patient’s perspective, and I looked forward to seeing it from the provider’s perspective. During a summer rural externship, I spent three weeks shadowing Carol Gambrill, …

Improve doctor visits by bringing checklists to check ups

Crystal Fornes, NP

Patient

October 28, 2012

Have you ever returned home from a visit with your doctor and realized that you forgot to ask the one question that you really wanted an answer to? I certainly have. In fact during a recent visit with my doctor, I had every intention of asking her about a vague symptom that I had been experiencing in recent months. It was on the forefront of my mind, but when I …

Pharma needs to embrace social media

Paul Tunnah

Medications

October 28, 2012

Anyone working in the pharma industry will know it has been a tough few years. Dwindling innovation in the drug pipelines, the impact of global economic pressures and an increasing global focus on healthcare cost containment have all combined in a perfect storm for the sector often regarded as recession-proof.

As the backdrop to all this, social media has rapidly been finding its place as a powerful media in sectors selling …

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Pharma needs to embrace social media