It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …
Gratitude from patients and their families
What is the physician’s most precious possession? Some might answer that it is his patients.
Others might respond it is the training and education that the physician has obtained to practice his (or her’s) craft.
But the real answer is that it’s the physician’s reputation.
Doctors live and die by their reputations. Reputations take years to …
Physician reputation management in the age of social media
How much attention do you pay to your Evaluation and Management (E&M) Coding practices?
E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide.
According to the Office of the Inspector General (OIG), Medicare paid $25 …
Doctors receive no training on coding, which makes them prone to fraud
Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.
This is a no-brainer situation – the patient is in sepsis and septic shock.
Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …
Do Not Resuscitate and the need for a central line
I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).
First a few words about primary care as a field: I found it to be both awesome and boring.
It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …
Why this medical student found primary care awesome, and boring
by Zakari Tata, MD
Many articles have been written on physician suicides. Yet nothing practical has been implemented. The problem is probably much larger than reported, as families will try to avoid publicity where possible.
In medicine, just as in the rest of society, people diagnosed with depression are wrongly labeled as weak, and discrimination, especially the subtle passive …
How to prevent suicide in physicians
When I go to the doctor for my yearly physical (OK, not quite yearly, but…) he puts me through the ringer. He asks me dozens of questions, follows up with more questions, and does a (thorough!) physical exam. Then he takes some blood, and sometimes runs some other tests. The big question is “why”? What are …
Prevention of disease and monitoring of chronic diseases in a yearly physical
What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.
Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added …
What should we expect of a physician leader today?
Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.
1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely …
Aspects of psychiatry this doctor appreciates
A guest column by the American Medical Association, exclusive to KevinMD.com.
The Centers for Medicare and Medicaid Services (CMS) has pushed back the April 1 deadline for states to implement their Medicaid recovery audit contractor (RAC) programs until an unspecified time later this year. The implementation delay was welcomed by the American Medical Association (AMA) and other national physician organizations who have vocally urged CMS to improve its proposed Medicaid RAC …
AMA push against Medicare recovery audit overreach
By now, most healthcare professionals — and many well-read consumers — are aware of the disturbingly high rate of surgical site infections (SSIs) in our nation’s hospitals.
Each year, approximately 500,000 surgical patients develop SSIs. In some types of operations, such as colorectal surgery, the rate is close to 10%.
Many hospitals submit information about SSIs in their institutions through the …
High rate of surgical site infections (SSIs) in our nation’s hospitals
If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?
Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.
But how do you know who’s on their game and who’s falling down on the job? …
Asking a doctor for their opinion on another physician
A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.
Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …
Hospitals taking over private practices
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Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.
This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is …
Successfully appeal an insurance company reviewer decision
An excerpt from In Stitches.
I see dead people.
Eighteen bodies covered with plastic, lying on gurneys. An occasional toe protrudes to verify that beneath the shiny black tarp, a dead person lies.
I smell dead people, too.
Or at least the thick chemical stench of formaldehyde, tearing at my eyes and packing my nose, enough liquid preservative in here to float a yacht. The smell rises from the bodies and from a dozen …
I see dead people, an excerpt from In Stitches
I believe primary care docs are rebelling against the system. The system has made primary care physicians suffer emotionally and financially. The system has taken the greatest form of medical care – that consisting of continuity, comprehensiveness, complexity and completeness – and denigrated it.
Now I talk about “the system” in an anthropomorphic sense, but “the system” is virtual. “The system” has no conscious, it is not deliberate, rather it represents …
Primary care physicians are rebelling against the system
Friday in my office is like happy hour for the oldest of the old.
They come. 90, 95, 100. Always on Fridays. Some come in wheel chairs. Others walking. Some alone. Others with family. 5,6, 7 sometimes even more in just one short morning. And we talk about life, about their children, about growing old. I apologize that at that age I really have little to offer. After all, they know …
Entering the golden age of hospice care
One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.
At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately. So what really is the difference between the two?
A complication may be described as …
Surgical error: The difference between mistake and complication
Proton beam therapy is an effective modality for killing certain types of cancer cells. New England and the Northeast are fortunate to have a proton beam machine at Massachusetts General Hospital, where it has been in use for some time effectively treating patients. This is a valuable resource, serving the entire region and beyond.
But what happens when everyone wants one? Well, we see the medical arms race at work again.
These …
Proton beam therapy and the medical arms race
Clinician. Diagnostician. Prognostician. Healer.
A physician has many jobs to perform, all critical to the appropriate management of what ails our patients. Without astute physical exam skills or a keen ability to sort through a medical history to uncover salient data, the physician is no better at diagnosing a patient than a Google search (and we’re quite a lot better, in case anyone was wondering). Without a proper understanding of physiology …
Viewing physicians source of care, rather than a barrier to care
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