How I met your mentor: tips to finding sponsorship and mentorship

Medical Education
August 16, 2018

If someone asked you on day one of medical school, as a fresh-faced first year, to name the essential components of a successful career, what would you have answered? A solid education? Good test scores? Publications? An $800 otoscope? Some are more obvious than others. Who of the enlightened among us would have mentioned a proper work-life balance? How about a strong support system — or the right mentor?
Navigating the …

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How I met your mentor: tips to finding sponsorship and mentorship

Do you run a financially independent business?

Physician Finance
August 16, 2018

Although I would never describe the business of primary care medicine as cutting edge, there are a number of innovations that have come and gone during my short tenure running a medical practice.  The business of medicine is fascinating and leaves much room for personalization and creativity.  I have been lucky to operate at the forefront of practice management and learned quickly how to leverage two bleeding edge philosophies to multiply profits. …

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Do you run a financially independent business?

A physician contemplates Medicare blended rates

Health Policy
August 15, 2018

I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to …

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A physician contemplates Medicare blended rates

The many ways to describe chest pain

Conditions and Diseases
August 15, 2018

There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.

But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …

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The many ways to describe chest pain

Don’t worry, this psychiatrist won’t analyze you

Physician
August 15, 2018

“Oh, you’re a psychiatrist? I hope you won’t analyze me!”

I never know what people actually mean when they say that upon learning that I work as a psychiatrist.

I think they’re saying, “I hope you’re not going to spend our time together trying to discern my flaws.” Nobody wants people to seek out, highlight, and exploit their vulnerabilities and faults, so I can understand that. Of course, that’s not what psychiatrists do.

Anyway, …

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Don’t worry, this psychiatrist won’t analyze you

Behold the power of gratitude

Physician
August 15, 2018

Gratitude may be more beneficial than we commonly suppose. One recent study asked subjects to write a note of thanks to someone and then estimate how surprised and happy the recipient would feel – an impact that they consistently underestimated. Another study assessed the health benefits of writing thank you notes. The researchers found that writing as few as three weekly thank you notes over the …

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Behold the power of gratitude

Sorry doctor, you’re already an actor

Physician
August 14, 2018

Following one of my recent articles on how physicians can improve their communication skills and ultimately help attain better patient outcomes, I received an interesting comment from a physician. It went something like this: “Sorry, but I’m not an actor.”

This response typifies a small (but not insignificant) subset of responses I get when I’m discussing and promoting techniques that any doctor can utilize to better their skills in this area …

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Sorry doctor, you’re already an actor

Structure case conferences as a primary way to teach and learn

Medical Education
August 14, 2018

When we studied ward attending rounds, the thought process represented the top attribute that learners valued.  Learners can learn facts from textbooks, but using those facts requires experience and role modeling.

I have given many lectures on clinical reasoning, and I have attended many lectures on clinical reasoning.  These lectures can entertain, but one lecture does little to help our colleagues and our learners.

We must structure case conferences as a primary …

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Structure case conferences as a primary way to teach and learn

Dear science: an appreciation

Physician
August 14, 2018

Dear science,

Today my sons, Oliver and Victor, are 15 years old.

It is not a miracle; it is thanks to you.

Unable to get pregnant I needed infertility therapy. If you had not isolated the hormones, developed tests, and then designed medications for ovarian stimulation and to trigger ovulation I would never have become pregnant.

If ultrasound had not been developed I would not have known I was pregnant with triplets and then …

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Dear science: an appreciation

Hospital mergers and the risk to patient safety

Health Policy
August 14, 2018

STAT_Logo

“Better patient care” is the reason hospital and health systems usually give when they merge or acquire one another. Our research suggests that mergers and affiliations might, paradoxically, increase the risk of harm to patients in the short run. Improving the safety of patient care is possible during mergers and affiliations, but requires intentional efforts.

What happens after …

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Hospital mergers and the risk to patient safety

4 disturbing trends in health care

Health Policy
August 13, 2018

It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.

Here are four trends that are changing health care but on the surface are too unsexy for us to care about.

Trend 1: The doctor-patient …

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4 disturbing trends in health care

Think you have an iodine allergy? You may want to reconsider.

Conditions and Diseases
August 13, 2018

Let’s begin with a quiz question:

Patients may be allergic to:

A. oxygen
B. carbon
C. iodine
D. none of the above

If you answered anything but “D,” better keep reading.

Consider this scenario: If a patient is allergic to penicillin, you would document “penicillin” in the medical records. It would never occur to you to list “antibiotics” as an allergy, and you certainly would not call it a “carbon” allergy for slang, just because penicillin contains …

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Think you have an iodine allergy? You may want to reconsider.

Making the world a better place for new medical interns

Medical Education
August 13, 2018

It’s that time of year again.

The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training.

Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn.

Now it’s our job to make sure they stay this way.

(Have I written this column before? Every year …)

We need to make sure we have a world where …

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Making the world a better place for new medical interns

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The evolving definition of doctor

Physician
August 13, 2018

Doctor: (from Latin docere “teach” Greek phusikḗ epistḗmē “knowledge of nature”) a specially trained and skilled person who holds an advanced medical degree and is licensed to practice the healing arts.

My definition of doctor keeps evolving. As a child, I was cared for by FPs who helped set bones, suture skin and fight infections like measles, chicken pox, and strep. Though I didn’t like going, I usually experienced healing on …

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The evolving definition of doctor

The nuances of a primary care visit aren’t always appreciated

Physician
August 12, 2018

I subscribe to a financial newsletter that happens to be written by a non-practicing physician in a highly specialized field. His daily updates are a mixture of financial and health advice, and he is a proponent of evidence-based medicine. Based on the letters from subscribers, they are willing to follow his advice eagerly, and when he gives some references to support his medical opinions this seems logical. But he is …

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The nuances of a primary care visit aren’t always appreciated

A private equity primer for physicians

Physician Finance
August 12, 2018

“My group has been approached by a private equity company.  It sounds like a great deal!  Any questions I should ask?”

Whether it be through one on one discussions or through the Physician Side gigs group, I’ve found myself having this conversation with increasing frequency.  Part of the reason for that is because I find it fascinating, albeit also sometimes terrifying.  As the trend towards consolidation …

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A private equity primer for physicians

Atul Gawande’s prescient 2012 TED talk

Health Policy
August 12, 2018
YouTube video

Health care is buzzing as Atul Gawande has been selected as CEO of the Berkshire-Hathaway/Amazon/JP Morgan strategic venture. I was thrilled they picked a physician, like myself, in the trenches to run their gig. After hearing the news, I remembered Gawande’s TED Talk from 2012 and decided to catch up on it during my flight to the Healthcare Finance Management Association Annual Meeting and Innovation Lab.

After watching the …

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Atul Gawande’s prescient 2012 TED talk

Don’t throw the E&M baby out with the bath water: the proposed CMS changes

Health Policy
August 11, 2018

By now, everyone has heard that the Centers for Medicare and Medicaid Services (CMS) has proposed to dramatically change how physicians get paid for evaluation and management (E&M) services in the office as part of the proposed 2019 Physician Fee Schedule Rule. In fact, as of the end of July, CMS has received over 600 comments on the proposed rule, with virtually all of them criticizing the proposal. I suspect …

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Don’t throw the E&M baby out with the bath water: the proposed CMS changes

New interns: Get ready to be fleeced

Medical Education
August 11, 2018

This one’s for the new interns.

You’re excited, you’re about to start residency. You’re a doctor. No more short white coat. You’ve got the long white coat that you’ve been waiting for. You’ve arrived.

But actually, there’s one more thing you need before you really feel like you look like a doctor. It might be a few months. There’s going to be a long process. Someone in your program, maybe the …

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New interns: Get ready to be fleeced

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