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Reform is suffocating private practice by design

Health Policy

February 19, 2013

Cleveland and northeast Ohio are not hospitable to private practice medicine. I should know. I’m one of them. Private practice is fading as health care reform suffocates it by design. When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.

Keep in mind that the first half of my professional career was spent as …

Advice for parents in medical school or residency

MomTFH, DO

Physician

February 19, 2013

Being a single mother in medical school and residency isn’t a piece of cake. But, being a single parent in this world isn’t a piece of cake, either, and being a medical student and / or resident isn’t a piece of cake. Foregoing medical school isn’t necessarily the answer to any of that.

Here is some general advice I will share with parents, single or otherwise, who are facing decisions about …

Physicians who hasten death should not be called doctors

Jeffrey Parks, MD

Physician

February 18, 2013

From the Economist in October 2012 was an article on physician assisted suicide. In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state. Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths). Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide …

My smartphone has become an ally in my weight loss program

J. Leonard Lichtenfeld, MD

Physician

February 18, 2013

Groundhog Day was on Saturday this year, and unlike the furry little beast, what I have to say each year around this time is just as good today as him looking for his shadow on Saturday.

What is all this about, you are probably asking yourself?

It is about an annual update that …

My first year as a locum tenens physician

Janice Boughton, MD

Physician

February 18, 2013

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that …

Stopping prescription drug abuse starts with primary care

Julie Craig, MD

Physician

February 18, 2013

As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America – up to five times higher than the national average. Our patients routinely lose family to addictions; our clinic has been home to a …

Is the history and physical examination worth performing anymore?

Gregory W. Rutecki, MD

Physician

February 17, 2013

Would it be silly to ask, “Is the history and physical examination worth performing anymore?” especially in this era of high-technology medicine? Does it matter if the diagnosis is made by the bedside in contrast to CT or echocardiography? Someone did ask, and the answer is intriguing and was debated. Let’s look at the data.

Four hundred and forty-two consecutive patients were admitted from the emergency department to an …

Healthcare businesses need better managers

Donald Tex Bryant

Physician

February 17, 2013

Do you read the comic strip “Dilbert” by Scott Adams? I read it most every day. It tells the story of an engineer named Dilbert and the people with whom he works, including notables such as Wally, Alice and the pointy-haired boss. Mr. Adams daily relates amusing situations of the dysfunctional relations at Dilbert’s work site. While the situations are hilarious at times, they reflect the actual work processes at …

Doctors: Keep your medical practice about medicine

Adam Banks

Physician

February 17, 2013

There’s certainly a lot of buzz surrounding the word “holistic” in the field of medicine lately. For the purposes of what I am talking about in this article, I assume that all, or at least most, doctors take a holistic approach to medicine. Meaning that they can think across many of the body’s systems, understanding how one condition or component affects the others, and considering each aspect of a patient’s …

MKSAP: 76-year-old woman with dizziness, shortness of breath, and palpitations

mksap

Conditions and Diseases

February 17, 2013

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

A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has a history of hypertension and heart failure with preserved ejection fraction. Medications are hydrochlorothiazide, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 80/60 mm Hg, pulse rate …

The deaf medical student: Why technical standards need updating

Josh Butler

Medical Education

February 16, 2013

A technical standard is a formal document establishing requirements in several aspects of medical care which all physicians-in-training candidates must possess. Most medical schools require that all candidates meet these requirements in order to receive their doctor of medicine (MD) degree. Some schools require students to sign that document when applying to a program or as a condition to matriculate into medical school.

I took a closer look at different technical …

Survivors of medical error need crisis intervention

Martha Deed, PhD

Patient

February 16, 2013

When health journalist Cheryl Clark wrote about the need for crisis intervention for “second victims” of medical error, defining “second victims” as medical caretakers, she struck a nerve. Recommending crisis intervention for staff, highlights the absence of meaningful help for injured patients and their families.

In Clark’s article, a hospital patient safety officer notes that medical error trauma is worse when hospital staff …

The less effectively we communicate, the more likely we are to be sued

Carla J. Rotering, MD

Physician

February 16, 2013

As a physician, do you care enough about your patients? It is my belief – and my experience – that physicians care deeply in ways that we demonstrate through our hard work, our commitment, and our willingness to go beyond the ordinary almost every day of our professional lives. What often gets “lost in the soup” of busyness is the communication of that caring in a mindful, purposeful and comfortable …

Part of medical education is to learn limitations

Neil Baum, MD

Medical Education

February 16, 2013

There is a strong relationship comparing sports to the military, business, and also to medicine. Young athletes, in their late teens and early 20s, are mostly brawn and use their strength and speed to achieve success early in their professional careers. As the athlete matures in their late 20s and early 30s, the physiologic processes slowly decrease and efficiency and maturity and other cerebral skills emerge.

There are 2 rainbow arcs …

MKSAP: 20-year-old man with a 6-month history of low back pain

mksap

Conditions and Diseases

February 16, 2013

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

A 20-year-old man is evaluated for a 6-month history of low back pain accompanied by prolonged morning stiffness. His symptoms improve over the course of the day, but he is now unable to play recreational soccer. Rest, physical therapy, and acupuncture have not improved his symptoms. Use of ibuprofen or diclofenac provides only partial …

The EMR template: I want to believe

Betsy Nicoletti, MS

Health Technology

February 15, 2013

The X-Files fans will remember the poster that Agent Mulder had on his bulletin board with a picture of a flying saucer and the words, “I want to believe.” That’s how I feel reading EMR notes sometimes. I want to believe, but I doubt.

I know how this happens. The EMR vendor, the practice implementation team and the doctor have a meeting to develop the “normal” template for a hospital admission …

Read more…

The EMR template: I want to believe

How the physician replaced the medical secretary

David Mokotoff, MD

Health Technology

February 15, 2013

I recently sat in a small room, in the bowels of a local hospital, training for the impending implementation of CPOE. For those not familiar with current health care acronyms, this stand for Computerized Physician Order Entry.

Nearing the end of my medical career, I could not help but admire the timing of this phenomenon. “They’ve finally done it,” I mused silently. They …