An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.
I bled.
With great pride, I skipped the obligatory required mandatory training session on “diversity awareness.” I skipped both the primary session and the make up session. The session, and its mandatory nature, had been carefully announced every day for weeks. The …
Hospital administrators are scared of JCAHO
Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …
What does it mean to be a medical intern?
The calendar says it’s time to think about the holiday shopping season, and planning for ICD-10. Oct. 1, 2014 is the date for submitting ICD-10 diagnosis codes. What’s your plan for the transition from ICD-9 to ICD-10?
The breadth of changes will have an impact your entire office. It’s obvious that your billing staff and coding staff will need training, but have you considered your other staff — those who schedule surgeries or …
What’s your plan for the transition to ICD-10?
Integral to the very concept of the patient-centered medical home is the need for a very real, very concrete, one-on-one relationship between the patient and his or her primary care provider.
No matter who this is, the patient needs to know who their internist, or gynecologist, or pediatrician, or nurse practitioner, or other primary care provider is. Nothing can replace this, and everything else about the patient-centered medical home is designed …
Knowing who your PCP is in the medical home
When I grow up, I want to practice “free medicine.” You may be asking yourself, “What is free medicine? Does he mean he wants to run a free clinic or give out free pills?”
Free medicine (FM) is a concept I just created in response to a comment from a reader on a recent blog post. My reader is a brilliant doc, educator and writer who serves both as mentor and …
I dream of practicing free medicine
Norman Rockwell never imagined a world where visiting a doctor could be compared to a trip through a Starbucks drive-thru. The days of shooting the breeze with patients and family members have been relegated to the “Good ole’ days” museum right next to Rockwell’s paintings portraying the doctor as more than just a healer, but a trusted friend. What happened to those days? With challenges like increased patient volumes and …
3 simple ways to improve our patient relationships
I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with …
A physician expert witness speaks out
We never know how high we are
Till we are called to rise.
-Emily Dickinson
It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press. It implies an ideal state, one which of course we cannot have. Never agonize over ideals when the problem is as urgent as death. Perhaps it should be renamed “the good-enough death,” one that is …
There is a cure beyond saving a life or the curing of an illness
Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.
Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …
Why insurance is the wrong model for health care
If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array of diagnostic information about illnesses, and direct treatment paths.
However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to …
Why health insurance for all obstructs lowering health care costs
In recent years, there has been a shift away from solo practice to group practice among physicians. The trend, which some say began in the early 2000s, appears to have accelerated with new incentives proscribed in legislation such as the Affordable Care Act. The push for accountable care organizations seems to be fostering the rapid reorganization of medicine from one based on …
Is the death of the solo practitioner a bad thing?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 …
MKSAP: 38-year-old woman with increasing fatigue and weight gain
He looked ahead, seeing his feet on the hearth. There was smoke rising from one of the three logs, and he marveled at the small flicker of flame that stretched up and ignited the smoke that swirled above the log, dancing briefly somewhat joyously, then gone again, smoke returning.
“You can’t say you weren’t warned,” she said.
He sat, reflecting on her words. So much years of work, so much effort, breadwinner, …
After a lifetime in medicine, where did the time go?
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To understand the Vicodin story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a high potential for abuse and severe dependence. They include all the opiate (narcotic) pain medicines, like morphine, oxycodone, and fentanyl. These medications must be prescribed on a paper …
Does restricting Vicodin make sense?
Thermography uses heat sensitive infrared cameras to image the body and measure heat emission.
Solid tumors, even when they are tiny, have an increased blood flow and inflammation compared with non-cancerous tissue. Theoretically this could lead to a thermal gradient between a cancer and the surrounding non-cancerous tissues. Some animal studies indicate that thermography might detect heat differences between inflamed and non inflamed tissue and so it was postulated (initially back …
Thermography for breast cancer screening: Where is the evidence?
In Pierce County, Washington, where I work, it is difficult to find a psychiatrist to care for psychiatric cases that are outside the scope of practice of a primary care physician. Our community is not unusual in this situation. There is a nationwide shortage of physicians specializing in psychiatry.
According to Tom Insel, MD, the director of the Institute of Mental Health in 2011 both the number of psychiatry residency programs and the …
When it comes to psychiatry, primary care could use the help
Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air.
The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents …
The remarkable resiliency of the human body
When I was in middle school, I went to Lake Tahoe with my best friend on a ski trip. I had only been skiing a few times before, and even though my friend was only twelve, she was already a talented and experienced skier.
She was patient with me, but I became increasingly frustrated as I had trouble going down even the most basic runs without falling. At one point, after falling …
Antidepressants and the placebo effect
New Jersey is considering following four other states in legalizing physician-assisted suicide. The Death with Dignity Act would allow people with less than six months to live to receive a prescription for a fatal cocktail and then to commit suicide at the time of their choosing in the privacy of home. Recently, I had the opportunity to participate in a debate on the merits of the proposed law. While I oppose this …
An argument against physician-assisted suicide
I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong …
The one little question that could save your life
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