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There is no oversight for prior authorizations. There should be.

Meds

December 6, 2015

The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”

The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …

The general radiologist is still valued. Here’s why.

Dr. Saurabh Jha

Physician

December 4, 2015

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.

Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …

Use the power of psychology to ace your medical school interview

Shirag Shemmassian, PhD

Education

December 4, 2015

Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.

In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.

So why do they even want to interview you?

Consider what schools can only learn about you in …

5 health questions every presidential candidate should answer

Robert Pearl, MD

Policy

December 2, 2015

With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …

Do psychiatrists have value? Yes, they do.

Maria Yang, MD

Physician

December 2, 2015

While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence.

I found nothing. (1)

“So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone.

I am an N of 1. …

Listening to the patient is the first part of the physical exam

Ira Nash, MD

Physician

December 1, 2015

The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …

Physicians are not providers: An open letter to the AMA and medical boards

Suneel Dhand, MD and William J. Carbone

Physician

November 30, 2015

Dear AMA and state medical boards,

The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.

Throughout this, one common theme has been the dedication and determination of hundreds of thousands …

I got rejected from medical school twice. It was the best thing that happened to me.

Antonio Webb, MD

Education

November 28, 2015

Most people who apply to a graduate school and/or graduate medical programs apply to get accepted the first time of applying. No one wants to have to apply a second time and definitely not a third time. After a second rejection, a lot of people would probably recommended someone picking another field to enter or even giving up altogether. For me, both of my rejections were taken hard and still …

If urgent care centers don’t innovate, how long will they last?

Stephen C. Schimpff, MD

Physician

November 27, 2015

Part of a series.

Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.

Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …

How doctors can establish an online presence: A step by step approach

Kevin Pho, MD

KevinMD

November 27, 2015

A continuing series on physician online reputation. Created in partnership with the Doctors Company as part of their social media resources for physicians.

There are so many online platforms that doctors can get involved in today, and some may not know where to start. I want to share my approach.

The first step would be going on physician rating sites and making sure your information is accurate on …

Physicians looking for a new job should beware these 4 red flags

Eve Shvidler, MD

Physician

November 26, 2015

Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin.

Last year was a …

Who’s in charge of the patient? It’s a question increasingly difficult to answer.

Ira Nash, MD

Physician

November 24, 2015

I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …

The question about education that this doctor asks every new patient

Greg Smith, MD

Physician

November 24, 2015

“How far did you go in school?”

This is a question that I ask every new patient as a matter of course.

Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.

Now, leaving the …

A physician’s personal experience with evidence-based medicine

Chad Hayes, MD

Conditions

November 24, 2015

It’s no secret that I have a special place in my electronically-regulated heart for evidence. There’s a good reason for that. Our primary job as physicians is to avoid harming our patients, but it’s followed closely by our calling to help them in some way. The problem is that, until we test our theories, we don’t really know which treatments will help our patients (or which ones might harm them), …

What worries me about husbands and wives in the exam room

Hans Duvefelt, MD

Physician

November 23, 2015

When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot.

I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never …

The bait and switch of health care IT

Suneel Dhand, MD

Tech

November 21, 2015

Last week I was playing golf with some friends. The Boston area has been having a bit of an Indian summer, and we are lucky to still be getting out there (long may it last). The conversation during one of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that’s just been installed in their …

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The bait and switch of health care IT

We lose a medical school full of physicians every year to suicide: An interview with Dr. Pamela Wible

Pamela Wible, MD

Physician

November 21, 2015

TEDMED-WIBLE-PHOTO-shrink

Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below:

Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at the …

DSM-5 is psychiatry’s maladaptation in the grey zone masquerading as science

Dr. Saurabh Jha

Conditions

November 21, 2015

The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save …

This doctor quit residency. And now she’s truly happy.

Anonymous

Physician

November 19, 2015

“I quit residency.”

Three words that many physicians couldn’t ever imagine coming out of their mouth, but for me, I say it all the time, usually with a smile on my face. I was a year and a half into my family medicine residency and decided it was enough. My decision mostly revolved around the birth of my son. My husband (a resident in the same program) and I planned to …

Value to patients and value to society: How can doctors balance the tension?

Joshua Liao, MD

Policy

November 19, 2015

Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.

Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …

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