Physician

How many patients can a doctor safely see a day?

Physician

December 31, 2013

Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.

With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …

Why are doctors the worst patients?

Natalie Azar, MD

Physician

December 31, 2013

We’ve all been there. You’re in medical school, sitting in a lecture hall — maybe the course is pathology — and for the first time since starting your studies, you’re actually learning about real diseases, not just benzene rings and the Krebs cycle. You’re furiously note-taking, and you reach back to work out a kink in your neck. There it is! A palpable, enlarged lymph node. You have lymphoma. You …

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Why are doctors the worst patients?

The job of the modern doctor is to convince

Tiredoc, MD

Physician

December 29, 2013

The job of a doctor isn’t to diagnose, prescribe, or examine. It isn’t to be well read, efficient, or punctual. The job of the modern doctor is to convince.

We now have radiological studies whose theoretical discernment limit is subcellular. We can not only map clear and obvious genetic errors of metabolism, but also minor variations of the normal. In a few years, the majority of codes in the procedure manual will probably be laboratory …

5 universal problems hospitals need to solve

Suneel Dhand, MD

Physician

December 27, 2013

As health reform sets in, hospitals are gearing up for many challenges. While some of these are new to the health industry, several are against the backdrop of old problems that have plagued us for decades. Speaking as a doctor who has worked in a number of different hospitals up and down the east coast, I would like to identify 5 of these that I believe are fairly universal.

1. Medication …

These are the people who work in a hospital

Maria Yang, MD

Physician

December 26, 2013

Who works at a hospital? (Again, just indulge me for now.)

Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical …

When children are abused by foster parents

S. Terez Malka, MD

Physician

December 26, 2013

I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, …

Waking up from cardiac arrest

David Sack, MD

Physician

December 24, 2013

I nearly died a month ago on a treadmill halfway through a stress test.

The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours …

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Waking up from cardiac arrest

Stop asking radiologists to rule out disease

Dr. Saurabh Jha

Physician

December 23, 2013

When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.

To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …

Anesthesiologist assistants should be able to practice in every state

Karen S. Sibert, MD

Physician

December 22, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who’ll be giving you anesthesia. If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking …

The downward spiral of the stubborn patient

Val Jones, MD

Physician

December 16, 2013

Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …

There is only one reason why I still accept Medicaid

Tiredoc, MD

Physician

December 15, 2013

To err is human. To really screw things up, you need government.

One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.

Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …

Doctors: 10 lessons from the humble bumblebee

Neil Baum, MD

Physician

December 7, 2013

Bumblebee_05

Practice medicine like the bumblebee.

We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …

An anesthesia practice is sold, and a warning to young doctors

Karen S. Sibert, MD

Physician

December 6, 2013

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We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.

The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …

The personal costs of a living donor liver transplantation

Meera Gupta, MD

Physician

December 5, 2013

Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism.

One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. …

Patients must be given the results of their tests

Fred N. Pelzman, MD

Physician

November 28, 2013

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …

Doctors who call patients hypochondriacs are committing malpractice

Zackary Berger, MD, PhD

Physician

November 25, 2013

There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”

First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them …

Don’t resign your professional license in the midst of an investigation

George F. Indest III, JD

Physician

November 23, 2013

Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following.

First, you should never voluntarily relinquish or resign your license after you know …

Going the extra mile for patients: How friendly is too friendly?

Claire McCarthy, MD

Physician

November 22, 2013

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …

The focus on patient satisfaction is enough to make you sick

BirdStrike, MD

Physician

November 19, 2013

All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …

Boxer at Rest: A physician’s interpretation

Jeffrey M. Levine, MD

Physician

November 16, 2013

Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …

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