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Health Technology

The communication revolution in health care may be doing more harm than good

It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen: "Welcome to (our new texting system). Now you…

It happened again.  Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen:

“Welcome to (our new texting system).  Now you can instantly and securely text about patient care with all of your colleagues.”

A few seconds later, a message popped up.  “You have one unread message.”  As with most other communication systems, …

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The communication revolution in health care may be doing more harm than good

Health Policy

Pay-for-performance is here to stay. Hospitals better pay attention.

It used to be that hospitals billed Medicare for the services they provided, and Medicare -- I know this is crazy! - simply paid the bills. Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue…

It used to be that hospitals billed Medicare for the services they provided, and Medicare — I know this is crazy! – simply paid the bills.

Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare …

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Pay-for-performance is here to stay. Hospitals better pay attention.

Medical Education

Are surgical residents really doing the cases they scrub on?

According to the Residency Review Committee for Surgery, "A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative…

According to the Residency Review Committee for Surgery, “A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.”

In nearly all instances, resident “determination or confirmation of the diagnosis, provision of …

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Are surgical residents really doing the cases they scrub on?

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Physician

What this physician learned from writing about psychiatry

Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at…

Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at work and thinking about the foundations of psychiatry while writing the section, I’ve felt cognitively impaired when thinking about what I should write here.

But the thinking never stops … and …

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What this physician learned from writing about psychiatry

Conditions and Diseases

What you need to know about migraine headaches in children

Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines -- and many adults who get them started getting them as children, even if they weren’t diagnosed…

Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines — and many adults who get them started getting them as children, even if they weren’t diagnosed correctly.

(And many adults who get migraines are still not being diagnosed correctly. Do you get “sinus” headaches? They’re almost certainly migraines. Yes, I know you feel congested with them. Yes, …

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What you need to know about migraine headaches in children

Physician

Connecting the lines between father and child

I both look forward to and despise Sunday mornings. I awake just before the sun and am on the road by 5:15 a.m. Although I dread being upright so early on the weekend, I rejoice because it is the only…

I both look forward to and despise Sunday mornings.  I awake just before the sun and am on the road by 5:15 a.m.  Although I dread being upright so early on the weekend, I rejoice because it is the only trip to work, all week, at a leisurely pace.  I see the new admits at the nursing home, run by the hospital if necessary, and return just as my family …

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Connecting the lines between father and child

Physician

When can I follow my intuition?

In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those…

In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation?

Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have …

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When can I follow my intuition?

Conditions and Diseases

MKSAP: 68-year-old woman with progressive abdominal distention

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of…

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

A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …

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MKSAP: 68-year-old woman with progressive abdominal distention

Physician

These doctors were shamed and bullied for being sick

We go to the doctor when we are sick. But what happens when doctors get sick? Who cares for them? All too often, physicians are threatened, harassed, even terminated for being ill. After reporting on a psychiatrist fired for having…

We go to the doctor when we are sick. But what happens when doctors get sick? Who cares for them? All too often, physicians are threatened, harassed, even terminated for being ill. After reporting on a psychiatrist fired for having cancer and a pediatrician bullied for her brain tumor, I’ve heard from many more physicians who are now courageously stepping forward to tell the truth — in …

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These doctors were shamed and bullied for being sick

Physician

Marking a melancholy anniversary

Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the…

Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the counter these days.

Today I saw her for a preoperative clearance. She finally decided to get an operation for her chronically sore shoulder. She had injured it many years ago>. In …

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Marking a melancholy anniversary

Physician

Small moments have a big impact on patients’ lives

This is a story of two deaths. These patients' stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them. I was surprised to see Mrs. Stevens' name on my schedule…

This is a story of two deaths. These patients’ stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them.

I was surprised to see Mrs. Stevens’ name on my schedule today. She came to the office last week, and I felt sure that she’d be too weak for another visit. But I was glad she’d made it, as I’ve become quite …

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Small moments have a big impact on patients’ lives

Physician

Physicians take note: Get personal with your patients

Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept…

Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know …

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Physicians take note: Get personal with your patients

Physician

Why doctors are rebelling against saving lives

When I was in medical school, “real” doctors saved lives. Period. Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school…

When I was in medical school, “real” doctors saved lives. Period.

Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school status of future psychiatrists.)

We disparaged these doctors because they could be saving lives and chose not to, because they were often paid (God forbid) out-of-pocket by their patients, and because they …

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Why doctors are rebelling against saving lives

Physician

8 ways doctors can help patients affected by the impending repeal of Obamacare

If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare). As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each…

If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare).

As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each day as an opportunity to improve our practice and work more closely with our teams. While our clinics and hospitals try to figure out how to streamline workflows in our EHRs, …

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8 ways doctors can help patients affected by the impending repeal of Obamacare

Physician

Holiday reflections from an oncologist

A Christmas Carol by Charles Dickens is one of the most beloved stories of all time. It is a classic story with a theme that resonates as we end the year and commence a new one. The story revolves around…

A Christmas Carol by Charles Dickens is one of the most beloved stories of all time. It is a classic story with a theme that resonates as we end the year and commence a new one. The story revolves around the main character examining his past, present, and future. He realized that key events have shaped his life and turned him into the man he is. Before the story ends, …

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Holiday reflections from an oncologist

Physician

It’s time to start teaching financial literacy to young physicians

The ultimate goal of every young physician while in medical school and residency should be to become a remarkable doctor. However, what if one of the biggest factors of being a great doctor was not addressed from the start? Financial…

The ultimate goal of every young physician while in medical school and residency should be to become a remarkable doctor. However, what if one of the biggest factors of being a great doctor was not addressed from the start?

Financial wellness may not directly correlate with being an incredible doctor, but stress can and does, and today’s young medical professionals have a lot on their plates — beginning with $200,000 in …

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It’s time to start teaching financial literacy to young physicians

Physician

My experience as a physician shaped my views on the LGBTQ community

As a physician from Ghana brought up in a very religious family, I must admit that when it comes to gay rights and other issues related to sexual minorities I was as far to the right as anyone could be.…

As a physician from Ghana brought up in a very religious family, I must admit that when it comes to gay rights and other issues related to sexual minorities I was as far to the right as anyone could be.  My first experience with openly gay individuals was when I came to the United States. Needless to say, gay behavior in Ghana was so stigmatized as to be nonexistent in …

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My experience as a physician shaped my views on the LGBTQ community

Physician

Can we say that women doctors are just better for everyone?

Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia. She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope. She closed the…

Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia.  She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope.

She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in …

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Can we say that women doctors are just better for everyone?

Physician

How a family physician gets to know her newly arrived refugee patients

The reason for Chandra’s office visit is to fill out form N-648. Chandra* is a fifty-nine-year-old Bhutanese refugee who has been my patient for the last nine months. Form N-648 is a six-page bureaucratic nightmare that is guaranteed to bring…

The reason for Chandra’s office visit is to fill out form N-648. Chandra* is a fifty-nine-year-old Bhutanese refugee who has been my patient for the last nine months. Form N-648 is a six-page bureaucratic nightmare that is guaranteed to bring my clinic day to a grinding halt. My refugee patients bring me this form to certify that they are unable to take the test to become a U.S. citizen due …

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How a family physician gets to know her newly arrived refugee patients

Physician

To the caregivers over the holidays: Thank you

In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals: “Isn’t it hard on your kids not to have…

In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals:  “Isn’t it hard on your kids not to have you home on Christmas?”  Thankfully, I was always able to answer truthfully, “no.”  With consistent effort and a no-nonsense attitude, my kiddos either didn’t know the difference because they were …

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To the caregivers over the holidays: Thank you

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