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Understand the medical economics of a primary care practice

Physician

February 26, 2011

If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice.

I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights …

Can I be a doctor with bipolar disorder?

Dinah Miller, MD

Physician

February 25, 2011

“I have bipolar disorder. Can I be a doctor?”

It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …

The torture and emptiness of psychological hoarding

Srini Pillay, MD

Conditions and Diseases

February 25, 2011

Humans are imbued with a competitive spirit. And as a result, we like to count our victories.

There are an infinite number of possibilities in human experience. And when the possibility of death looms over us, the sudden fear that we might not have done everything we might have creates immense distress. This “range” or “number” idea rarely has the effect it is supposed to have. Every kind of sex, every …

Save the Boobs, and whether humor has a role in breast cancer

Jackie Fox

Patient

February 25, 2011

Last year it was the “Save the Boobs” video. This year it’s the “I (Heart)Boobies” bracelets.

Some people were very offended by the video’s slow-motion close-ups that were more reminiscent of a beer commercial. Now, some schools are banning kids from wearing the bracelets. And in a recent post on Salon, Tracy Clark-Flory made the eloquent case that we’re more than the sum of our body parts, and recounted her mom’s battle with metastasized lung cancer.

I agree …

Sharing information about your health with specialists is difficult

Jessie Gruman, PhD

Patient

February 25, 2011

As far as my chemo nurse Olga (not her real name) is concerned, I can do nothing right.

She scolded me for sending an e-mail when she thought I should have called and vice versa. She scolded me for going home before my next appointment was scheduled. She scolded me for asking to speak to her personally instead of whichever nurse was available. She scolded me for calling my oncologist directly. …

When your privacy is violated in the doctor’s office

Joel Sherman, MD

Patient

February 25, 2011

Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.

Most can accept it when we’re treated with modesty and respect. But not many are prepared for those times when you might be unnecessarily exposed or treated rudely. The possibilities for embarrassment are endless and it is usually unexpected. When avoidable incidents do happen, most patients are not prepared to speak up. Many …

Gastric bypass is not a short cut to treat obesity

Michael Kirsch, MD

Conditions and Diseases

February 24, 2011

Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.

As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …

Is alcohol good for me? The data behind drinking and your heart

Kevin

Conditions and Diseases

February 24, 2011

by Aditya Mattoo, MD

Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking …

How two different attending physicians approach similar conditions

MomTFH, DO

Physician

February 24, 2011

I recently finished my second month of internal medicine. I had a different attending physician for each month. It is interesting to see how two different attending physicians will approach similar conditions. There is a lot of flexibility in the standard of care. Neither of them is wrong by any stretch of the imagination. Just different.

It is also amazing how much of a difference a good, well informed resident can …

A balanced approach to informed consent

Kevin

Patient

February 24, 2011

by Zakari Tata, MD

Informed consent has continued to generate a lot of interest in medicine worldwide.

The reason is because patients in medicine and subjects in clinical trials need protection from the multitude of injuries and harms that have been caused by intentional or accidental actions. The controversies generated by various lapses of informed consent, in my opinion, have not been addressed and more safeguards need to be put in place …

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A balanced approach to informed consent

Physicians who are able to feel compassion

Jill of All Trades, MD

Physician

February 24, 2011

Here’s a true story from the operating room:

Surgeon: Intern, what is the story behind this patient?

Resident Intern: Patient is a 51 year old female with breast lump on the left side, and 17 out of 20 lymph nodes positive for cancer.

Surgeon (speaking in a rather ‘as a matter of fact’ tone): Oh, she’s F_ _ _’d.

Resident Intern: shocked, frozen and unable to respond.

“How do some physicians become so stoic?” I …

Physicians disgrace the University of Wisconsin with fake doctor notes

Kevin Pho, MD

KevinMD

February 23, 2011

One of the stories circulating regarding the demonstrations in Wisconsin is the authenticity of the doctor work notes.

Squarely in the cross-hairs are physicians from the University of Wisconsin’s Department of Family Medicine.

According to this excellent piece in The Atlantic by physician-writer Ford Vox,

In videos breathlessly presented throughout the conservative mediasphere this weekend, doctor after doctor is videotaped writing patently fraudulent sick notes so that the protesting teachers (whose contracts …

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Physicians disgrace the University of Wisconsin with fake doctor notes

How important is a doctor’s skill in the physical exam of a patient?

John Mandrola, MD

Patient

February 23, 2011

How important is a doctor’s skill in the physical examination of a patient?

To the lay person, a doctor’s examination might seem really important. “Of course it is, Dr M … Come on.”

But is it so? Or, perhaps, is the examination a charade, a show, a necessity to complete the medical record.

It turns out that many in the profession think doctors may be losing the skill of palpating and listening. At …

How medical loss ratios impact mini-med policies

Roger Collier

Health Policy

February 23, 2011

It’s amazing how much trouble a couple of hundred inexpensive health insurance policies can cause.

Up until recently, few people were aware of the existence of so-called mini-med policies. Marketed primarily by for-profit insurers Aetna and Cigna, they are designed to provide bare-bones coverage to employees of low-wage low-margin service companies. Unlike other approaches to affordable insurance that emphasize catastrophic coverage, mini-meds typically keep premiums affordable (some as low as $15 …

Evolution of tablet devices for the hospital

David Ahn, MD

Health Technology

February 23, 2011

When working in the hospital, I intentionally minimize the time I spend on my iPhone because I don’t want people to assume that I’m just checking Facebook or playing Angry Birds.

Even though medical apps and the vast depths of the internet are at my fingertips, it’s just too easy to appear distracted. This represents a subtle, yet meaningful, glimpse of just one reason why I eagerly await the continued evolution …

Revenue cycle management for your physician practice

Rosemarie Nelson

Physician

February 23, 2011

Revenue Cycle Management. What does it mean? In a nutshell, it means taking steps to assure that you get paid for what you do and that you get paid in a timely fashion.

The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient’s name, phone number, and maybe the name of their insurance company.

The cycle ends when the balance on their account …

When should psychiatrists give advice to patients?

Jeffrey Knuppel, MD

Patient

February 23, 2011

This post was inspired by Dinah, a psychiatrist over at Shrink Rap.

She recently described how a psychiatrist friend of hers has been going through some phase-of-life changes. Recently he has regretted some of the advice that he previously had given to patients who were going through the same life changes he’s now going through himself. He realizes that he was not nearly so qualified to give the advice …

How patients and doctors can improve the primary care office visit

Kevin Pho, MD

KevinMD

February 22, 2011

Consumer Reports recently released a survey of both patients and primary care doctors, regarding their perceptions of each other.

Some interesting findings, as summarized by the WSJ’s Health Blog:

On the issue of respect and appreciation, 70% of doctors said they were getting less of it from patients than when they started practicing. For patients, meantime, the more they reported being treated respectfully and listened to, the more satisfied they were …

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How patients and doctors can improve the primary care office visit

How to improve doctor patient communication

Paul Dorio, MD

Patient

February 22, 2011

When I was a medical student on my first clinical rotation, obstetrics, I was criticized for not using enough medical jargon when I spoke to the patients.

I took that criticism as a compliment and have always attempted to speak clearly and without too much “inflation” of my terms. In my opinion, the more clearly we physicians communicate, the better will be our patients’ understanding of their ailments.

The important topic of doctor-patient communication led a …

Why alternative care seems to work

Peter J. Weiss, MD

Patient

February 22, 2011

People sort of want to try alternative care. They’re working up to it, but then they read more about it; they read about the theory and they say, “No I don’t believe that theory. That can’t possibly work. There’s nothing to it. I’m not going to do it.” But, the problem is that the theory of why something works or the explanation is not necessary related to the effect of …

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Why alternative care seems to work

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