Violence in the emergency department puts patients and physicians at risk

Health Policy
October 2, 2018

The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day.

A new poll by the American College …

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Violence in the emergency department puts patients and physicians at risk

5 urban legends about risk-adjusted diagnosis coding

Health Policy
October 1, 2018

When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends!

Let’s separate fact from fiction.

Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value

Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are …

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5 urban legends about risk-adjusted diagnosis coding

One of the biggest lessons medical school can teach you

Medical Education
October 1, 2018

I spent my first two years of medical school collecting stories. I journaled about my thoughts in the anatomy lab. I wrote about what it was like to learn how to interview and examine patients, about the immense honor and privilege I felt just being able to don a white coat with a stethoscope around my neck. I wrote about the patients that touched my heart – the patient with …

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One of the biggest lessons medical school can teach you

Humanity in medicine is in crisis

Physician
October 1, 2018

“There’s no heartbeat.”

Three words no one ever wants to hear.

Three words no one ever wants to deliver.

And yet, as a community of physicians, we deliver those crushing words on a daily basis. None of us would ever take the task of bearing this piece of news lightly, but for me, it was not until I was on the receiving end of them that I truly grasped how profoundly a physician …

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Humanity in medicine is in crisis

Don’t sign off on fat acceptance. Don’t normalize obesity.

Conditions and Diseases
October 1, 2018

I cannot get behind fat acceptance, or better stated in medical lingo as “normalizing obesity.” As a physician and as someone who has been obese or morbidly obese my adult life, I know first hand what it’s like to hate my body and feel ashamed of it. I still do this very moment as I type this, that’s something I have to work on.

Funny thing is, I am much more …

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Don’t sign off on fat acceptance. Don’t normalize obesity.

CURES is not a fix for the opioid crisis

Health Technology
October 1, 2018

The California Department of Justice mandate to consult CURES (Controlled Substance Utilization Review and Evaluation) prior to prescribing, ordering, administering, or furnishing a Schedule II, II or IV controlled substance becomes effective on October 2, 2018.

The law states that CURES must be consulted the first time a patient is prescribed, ordered or administered a Schedule II, III or IV controlled substance. CURES must be consulted every four months thereafter if the …

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CURES is not a fix for the opioid crisis

The answer to your prior authorization problem is simpler than you think

Medications
September 30, 2018

Prior authorizations (PAs) have become increasingly burdensome for providers — they contribute to 92 percent of care delays and an estimated 77 million are submitted manually each year. In fact, the process has become so burdensome that many physicians get fed up with the process end up writing for less-effective prescriptions because they know the preferred drug will require a prior …

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The answer to your prior authorization problem is simpler than you think

What my young patients taught me about parenting

Physician
September 30, 2018

Despite meticulous time management and delegation as a doctor, there were times when I found cobwebs on the laundry left on the clothesline too long, or a moldy school lunch or squashed banana forgotten at the bottom of a school bag at home. I would ensure all the important school dates were in my diary, but I was often tripped up by the curriculum day when school was suddenly off …

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What my young patients taught me about parenting

Sometimes the most entitled people aren’t those you expect

Physician
September 30, 2018

As I sat in a frozen yogurt store a couple of years back, I watched as two young men pulled up in an expensive vehicle. They were wearing athletic attire from a private faith-affiliated university in the neighborhood. Both grabbed sample cups and cup-by-cup consumed about ten dollars-worth of yogurt each before jestfully yelling “Gracias” to the Latin store employee and walking out the door without paying for anything. Then …

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Sometimes the most entitled people aren’t those you expect

No, the flu shot doesn’t cause the flu

Conditions and Diseases
September 29, 2018

Does the flu shot cause the flu?

Let me tell you, without a doubt, that the flu shot does not give you the flu. This is perhaps one of the most common misconceptions I hear as a physician. People absolutely swear by it. I’ve even had people tell me that family members got the flu shot and then died suddenly. I’m sympathetic, but how misguided!

Before we talk more about the flu …

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No, the flu shot doesn’t cause the flu

The practice of medicine has experienced its own version of climate change

Health Technology
September 29, 2018

When you or a loved one is sick or injured, health care decisions are fundamentally a matter of trust.  You trust your physician will have the answers you need, because you know that, as a highly-trained medical professional, they’re qualified to make the best recommendation for each and every patient under their care.

Physicians receive some of the most rigorous education and training of any profession. They spend the better part …

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The practice of medicine has experienced its own version of climate change

A new way to reduce sugary beverage consumption

Health Policy
September 29, 2018

The beverage industry derailed the movement for soda taxes in California by convincing state elected officials to pre-empt local taxing authority in exchange for cancelling a ballot initiative that would have made all new taxes difficult to pass. But taxes are not the only way to reduce sugary beverage consumption in California or the U.S. as a whole.

The beverage industry has come up with several ideas on how to …

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A new way to reduce sugary beverage consumption

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MKSAP: 56-year-old man with painless intermittent bloody urine

Conditions and Diseases
September 29, 2018

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

A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks’ duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for 3 years and oral cyclophosphamide for 1 year. He also has hypertension …

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MKSAP: 56-year-old man with painless intermittent bloody urine

Children of war: inherited bereavement

Conditions and Diseases
September 28, 2018

The children of survivors are important to the Holocaust story.  The children are the future of the past.  For a time, it seemed that no one would be left to create a future.  That history has been so carefully, lovingly chronicled.  It must be preserved.  If it is preserved and told, the possibility exists that there will be no more war.  That is always the hope of the survivors.

This is …

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Children of war: inherited bereavement

Inaccurate penicillin allergies worsens antimicrobial resistance

Medications
September 28, 2018

September 28, 2018 marks 90 years since Sir Alexander Fleming discovered penicillin as an effective antimicrobial which would soon save millions of lives. He warned soon afterwards that unless we used penicillin judiciously, we would see antibiotic resistance, and he was right. With decades of inappropriate antibiotic prescribing, we have dug ourselves a deep hole of antimicrobial resistance, and inaccurate penicillin allergies is but one shovel used to put us …

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Inaccurate penicillin allergies worsens antimicrobial resistance

Simplicity is the cure for our complex health system

Health Policy
September 28, 2018

In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings.

To simplify things a bit, every health care system on earth has three main stakeholders:

  1. Patients
  2. Physicians and clinicians
  3. Administrators

Yes …

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Simplicity is the cure for our complex health system

My younger brother’s brush with death

Physician
September 28, 2018

“Do your parents realize that he could die?”

I had been summoned to the workspace of the ED physician who was trying to save my brother’s life. I remember noticing that he was short with thick brown hair and a crisp white coat which were both too tidy and incongruent with the message he was delivering. He struck me as someone who was earnestly playing the role of a physician instead …

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My younger brother’s brush with death

A retirement reflection on the cycle of renewal

Physician
September 28, 2018

Just over a month has elapsed since my retirement from patient care. I’ve been to one grand rounds at my prior medical center, encountering a smattering of old friends, some preceding me to retirement, others in active discussions with their financial advisers and others a mixed multitude of residents and students assigned to the secondary campus that month looking upon us geezers in the small video access conference room with …

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A retirement reflection on the cycle of renewal

Every patient has a story

Patient
September 28, 2018

A thought, a word, a story. Simple concepts in a complex world, but they can have a profound effect on how we live our lives. Today’s world may seem, at times, a blur. We are inundated every day with headlines of natural disasters, man’s inhumanity to man, and simply, just life slapping us in the face. How can we maintain a sense of sanity and security when the world around …

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Every patient has a story

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