KevinMD.com

October 19, 2012Oct 19, 20125

Over the past several decades medical costs in the United States have escalated rapidly, exceeding the pace of inflation and threatening bankrupt to Medicare. As we heard in last week’s presidential debate, different solutions have been proposed on how to slow Medicare’s growth and reduce cost. President Obama highlighted his administration’s success in tackling fraud and waste within the system. This strategy appears to be supported across party lines. On …

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Why upcoding isn’t necessarily fraud

Patient voices

The hidden shame of elder abuse

Lillian Jeter

October 19, 2012Oct 19, 20123

Behind the doors of our communities throughout America lies a hidden shame as well as daily criminal acts called elder abuse. These crimes are committed on our most vulnerable and dependent elderly - those with dementia, Parkinson’s, unable to walk,…

Behind the doors of our communities throughout America lies a hidden shame as well as daily criminal acts called elder abuse. These crimes are committed on our most vulnerable and dependent elderly – those with dementia, Parkinson’s, unable to walk, oftentimes bedridden, and unable to cry out in pain.

Even more horrific are the abuses and neglects which occur in the “sanitized” corridors of the for-profit nursing homes throughout the country. …

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The hidden shame of elder abuse

Physician voices

Why using your cell phone during a visit distracts me

Heidi Roman, MD

October 19, 2012Oct 19, 20125

It happened again three times in clinic today. In the middle of a patient visit, a parent picked up their cell phone. To answer a call, to text a friend, to read their email. The trend of being always connected and available has reached the exam room. When this first started happening I was sort of incredulous. I mean, I’m there, talking to you about your child’s health, and you’re …

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Physician voices

My worst nightmare was not coming true, someone else’s was

BirdStrike, MD

October 19, 2012Oct 19, 20124

Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases. One hectic morning before my shift, my wife and I rushed around the house trying to…

Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases.

One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school. On this day, my daughter was to go on a field trip where the teachers would walk the kids through the city to the local …

Physician voices

Having our own doctor treat us in the hospital is a thing of the past

John Schumann, MD

October 19, 2012Oct 19, 20123

Health care reform is a locomotive barreling down America's tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that…

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

Patient voices

A driver’s license that needed rescinding

Emily Gibson, MD

October 19, 2012Oct 19, 20123

“Wait until you see what is waiting for you in the next exam room …” My clinic nurse was barely able to contain a smirk. This meant one thing to a doctor in training: the next patient must be a…

“Wait until you see what is waiting for you in the next exam room …”

My clinic nurse was barely able to contain a smirk. This meant one thing to a doctor in training: the next patient must be a “train wreck,” with so many things wrong that I would never get beneath the surface during my brief visit. I was running 30 minutes behind, so I took a deep breath.

As …

Physician voices

Find out whether your electronic medical record is accurate

Melody T. McCloud, MD

October 18, 2012Oct 18, 20128

Because someone rammed her SUV half-head-on into my car, this physician-surgeon has, of late, been a patient at physicians’ offices and outpatient surgical centers; and while medical sights, sounds, and sharp scalpels don't scare me, one thing I've discovered about…

I love my profession. I am a stickler for accuracy, and I like reviewing patient charts. I always secure a copy of …

Physician voices

I’m sorry I was your last memory before dying

Jordan Grumet, MD

October 18, 2012Oct 18, 201210

I'm sorry. I really am. No one deserves breast cancer. Especially the kind that spreads to your liver, lungs and brain. The fact that you lived to your eighth decade doesn't detract from the sadness. You deserve to live. I…

I’m sorry.

I really am. No one deserves breast cancer. Especially the kind that spreads to your liver, lungs and brain. The fact that you lived to your eighth decade doesn’t detract from the sadness. You deserve to live. I can’t blame you for not being ready to go.

I apologize that our meeting was so abrupt. I was consulted to see you in the nursing home to address various issues. I …

Physician voices

I am proud to have my father’s hands

Miranda Fielding, MD

October 18, 2012Oct 18, 2012

I never gave my hands much thought until a few years ago. They were never pretty, but they were functional serviceable hands that did what they were asked—I could examine a patient, type fast and accurately enough, and everyone always told me that my handwriting was outstanding. That has always been a point of pride for I knew that I was never going to kill a patient because a pharmacist …

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I am proud to have my father’s hands

Health policy

Reward doctors for evidence based problem solving, not test ordering

Robert Dickman, MD

October 18, 2012Oct 18, 20125

More than 40 years ago as a third year medical student, I recall the Chief of Medicine praising a fellow student for his rare diagnosis of paroxysmal nocturnal hemoglobinuria in a patient who had presented with the common symptom of “painless hematuria.” The lesson was not lost on any of us: good medicine means an expansive differential diagnosis and an even longer list of tests (including expensive ones) to “rule them …

Physician voices

When can a doctor call in sick?

Genmedmom, MD

October 18, 2012Oct 18, 20125

I struggle every time I'm ill. This week, it's not so much my own illness that's been the major problem. It's the kids. Because they can't sleep. And if they can't sleep, we can't sleep. It started last week with…

I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.

It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one …

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When can a doctor call in sick?

Physician voices

Did you do your Pap prayer?

Pamela Wible, MD

October 18, 2012Oct 18, 20123

An excerpt from Pet Goats and Pap Smears. Joy is a vibrant twenty-six-year-old woman who comes in for a physical. On her exam, she shows me a worrisome mole on her left shoulder. I recommend she return for removal. After…

An excerpt from Pet Goats and Pap Smears.

Joy is a vibrant twenty-six-year-old woman who comes in for a physical. On her exam, she shows me a worrisome mole on her left shoulder. I recommend she return for removal. After the excision, I call her back to my office for results.

“You have a melanoma. We got it just in time, but I’m sending you to a dermatologist who …

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Did you do your Pap prayer?

Physician voices

Why the RVU system gives a false sense of productivity

Brandon Betancourt

October 17, 2012Oct 17, 2012

One of my biggest problems of the RVU system is that it decided by a secret society composed of specialists. Nobody seems to have a problem that a “secret society” decides how much work and how much cost should be…

Medical procedures are very dangerous and have a lot of risk, but so is trying to provide healthcare to a complicated 2-year old that can’t tell …

Health policy

The upcoding firestorm: Why doctors are unfairly targeted

Shadowfax, MD

October 17, 2012Oct 17, 201211

There was an interesting and important article in the New York Times the other day about the gradual increase in the average E/M coding levels used by doctors over the last few years. For the non-docs, med students and ER…

There was an interesting and important article in the New York Times the other day about the gradual increase in the average E/M coding levels used by doctors over the last few years. For the non-docs, med students and ER trainees out there, here is a brief summary of the way physician billing works in the ER.

During and after the patient encounter, the physician creates a medical …

Physician voices

What would you include in your perfect school lunch?

Ricky Choi, MD

October 17, 2012Oct 17, 20122

A few weeks ago, my daughter took her first steps into formal education and entered kindergarten. I have been a little surprised to find this has involved a transition not only for her, but for me, too. Not only do her mother and I want her dressed comfortably and ready to learn, we have to plan or pack a meal that she will eat without us …

Physician voices

Some patients need absolution, not medicine

Albert Fuchs, MD

October 17, 2012Oct 17, 201211

My heart is blighted like grass, and withered, for I forget to eat my bread. –A patient’s prayer, Psalm 102 I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More…

My heart is blighted like grass, and withered, for I forget to eat my bread.
–A patient’s prayer, Psalm 102

I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More often, I just reassure them that they’re going to be ok. Or I give them advice about what they need to do to live healthier. But what I do has limits, and …

Drugs and prescribing

Why clinical decision making in psychiatry is difficult

Julia Frank, MD

October 17, 2012Oct 17, 2012

“All psychiatrists do is push drugs!” I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help. For some reason, no one…

“All psychiatrists do is push drugs!”

I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help. For some reason, no one makes the same complaint about infectious disease specialists, or oncologists, though I wager that the success rates of our drug treatments are roughly equivalent.

As a psychiatrist, I try to treat people …

Health policy

AMA: Prescription for the future of medicine

American Medical Association & Jeremy Lazarus, MD

October 17, 2012Oct 17, 20124

A guest column by the American Medical Association, exclusive to KevinMD.com. As our nation’s health care system undergoes historic reforms, the American Medical Association (AMA) has embarked on a long-term strategic plan that seeks a better future for medicine –…

A guest column by the American Medical Association, exclusive to KevinMD.com.

As our nation’s health care system undergoes historic reforms, the American Medical Association (AMA) has embarked on a long-term strategic plan that seeks a better future for medicine – both for the physicians who make it their profession and the patients who count on us for care. Our focus is anchored in the belief that there is a national imperative …

Medical education

Are pregnancy and residency compatible?

Linda Brodsky, MD

October 16, 2012Oct 16, 201213

Viewpoint #1. Training programs might say: we are headed for a major league collision in the training of women physicians. Soon 50% of all trainees will be women, and in some specialties, such as OB/GYN, they will be 80-90% of…

Viewpoint #1. Training programs might say: we are headed for a major league collision in the training of women physicians. Soon 50% of all trainees will be women, and in some specialties, such as OB/GYN, they will be 80-90% of the residents in any particular program. Training years coincide with prime child bearing years. Imagine if even only half the residents in a program were pregnant at once. What would happen …

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Are pregnancy and residency compatible?

Real physician voices, twice a week

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