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The RUC survives and now our health system is worse off

Health Policy

February 14, 2013

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On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …

Medicine requires doctors to constantly manage probabilities

Robert Fenster, MD

Physician

February 14, 2013

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“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”

Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I …

2 missed opportunities to teach fall prevention

Louise Aronson, MD

Conditions and Diseases

February 14, 2013

Two famous American women. Two missed opportunities for improved quality of care and patient safety in America.

In December, it was Hillary Clinton and in January, Barbara Walters. Both women fell, hit their heads, and ended up in the hospital. In each case, the focus of the media coverage reflected one of the biggest flaws in our American approach to medicine: readers and viewers learned about the costly and relatively high-tech …

Medical students: Be sure to thank your patients

Reflex Hammer

Medical Education

February 14, 2013

When listening with a stethoscope to a patient’s heart, one sometimes hears a deviation from the typical “lub-dub” rhythm. Sometimes the “dub” is too loud, or the “lub” too soft. There might be a rubbing sound, or a harsh blowing sound. By interpreting subtle characteristics such as the location, pitch, and timing of these sounds, one can sometimes diagnose things like a diseased heart valve or congestive heart failure. Read more…

Medical students: Be sure to thank your patients

Is the goal of patient satisfaction to make patients happy?

Mark A. Rudolph, MD

Physician

February 13, 2013

The link to a recent article in Forbes magazine entitled, “Why Rating Your Doctor is Bad for Your Health” keeps showing up in my inbox with the subject, “thought you would find this interesting.” The reason is because I’m responsible for overseeing education and training related to physician communication and patient satisfaction for a large national hospitalist practice.

The article isn’t so much interesting as it is unfortunate. Its …

AMA: Join physicians and medical students in advocating on key issues

Jeremy Lazarus, MD

Potpourri

February 13, 2013

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This week, hundreds of our fellow physicians and medical students gathered in Washington, D.C., for the AMA’s National Advocacy Conference, which is held in the capital city each February. Attendees heard from members of Congress, top administration officials including HHS Secretary Kathleen Sebelius, journalists and other experts about the health policy issues affecting …

Mourning the death of my medical practice

Michael Chen, MD

Physician

February 13, 2013

“I did it,” I mumbled to myself.

The numbness overwhelmed my immediate sense of dread throughout my body. I was trembling inside, full of anguish and at the same time, unable to contain my seething anger over an uncontrollable destiny. Just a few minutes ago, I turned off her life support system. The series of beeps had slowed down, pace by pace, like the ritardando in a finale movement of a concerto. …

6 tips for getting your doctor to listen to you

Leana Wen, MD

Physician

February 13, 2013

Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?

Studies show that Read more…

6 tips for getting your doctor to listen to you

ACP: Medicine up in the air inflates patient expectations

Yul Ejnes, MD

Physician

February 13, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Medicine is big business. If you don’t believe me, the next time that you travel by plane, pick up the airline magazine in the seat pocket and read the ads. If the advertising is a reflection of the air traveling …

You’re still a doctor, even if you’re not on call

David Gelber, MD

Physician

February 13, 2013

Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.

“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.

Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.

So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …

Behind the exam room door: It will be astonishing to me

Emily Gibson, MD

Physician

February 12, 2013

I have the privilege to work in the medical profession where astonishment and revelation awaits me behind each exam room door.

In a typical clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I must peel through the layers of a person quickly to find the core of truth about who they are and why …

10 reasons why I love Medicare as a physician

Floyd B. Russak, MD

Physician

February 12, 2013

I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:

1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while …

Why doctors should not ask patients about guns: A conservative case

Paul Hsieh, MD

Physician

February 12, 2013

Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics …

Doctors are the canaries in the coal mine of medicine

Dike Drummond, MD

Physician

February 12, 2013

Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.

When there is bad air in the mine, the canary’s sensitive lungs will cause …

Should spiritual beliefs play a role in end of life care?

Jim deMaine, MD

Physician

February 12, 2013

William would come to see me every three months for his COPD (chronic obstructive pulmonary disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her.

On one visit he said, “Doctor deMaine, can I tell you something – and promise you won’t think I’m crazy?”

“Sure.”

“Well, my wife …

Diagnosed with brain cancer: An insurer adds to the nightmare

James Bliwas

Patient

February 11, 2013

When my 40-year old sister was diagnosed with terminal brain cancer, her one, overriding wish as the days ticked down was to die in her own home with her husband Steve and me sitting next to her, eating meals she liked that we cooked as opposed to coping with the institutional food she was being served, and for her three beloved cats to be lying on the bed with her.

It …

The creative destruction of the American family physician

Mitchell Brooks, MD

Physician

February 11, 2013

Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides. Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion.

The …

OpenNotes in geriatrics: 6 awkward concerns

Leslie Kernisan, MD, MPH

Physician

February 11, 2013

I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.)

My first reaction was to be impressed by this bold progressive move.

My next reaction was to …

An epic fail when it comes to mental health

Peter Elias, MD

Physician

February 11, 2013

Sometimes the health care system just does not work.

I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …

Needle exchanges: When the perfect is the enemy of the good

Ishani Ganguli, MD

Physician

February 11, 2013

Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston’s South End. I consult my iPhone one more time to confirm that I’m in the right place and knock on the vehicle’s glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on …

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