Ambulatory medicine today: Focus on what you can control

Physician
November 20, 2022

Patient volume has recovered across the country, and most medical offices are back to a steady state of care delivery—but ambulatory care has changed irrevocably. We’ve entered a phase shaped by crisis and marked by even more intense cost pressure and consolidation. What steps can independent medical practices take now to help ensure stability and prosperity moving forward?

Offer employees a more rewarding work experience.

The great resignation—unprecedented turnover in the labor …

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Why is collaboration missing in health care?

Physician
November 20, 2022

An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.

Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise …

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We’re confusing resilience with grit [PODCAST]

Podcast
November 19, 2022
YouTube video

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“It’s not that physicians need to be more resilient. We’ve failed to provide them with the goodwill to be human and embrace their “whole selves” (people who are resilient often but not always), access to safe and …

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Depriving women of this drug is good public health

Meds
November 19, 2022

It’s a public health win that on October 19th, an FDA Advisory Committee voted 14-1 to remove Makena, a drug intended to prevent preterm birth, from the market. The FDA usually follows the advice of its advisory committee, and the briefing documents it supplied the committee make it clear that the agency wants the drug off the market. As well it should. Makena doesn’t work.

After a preliminary trial showed that …

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Political creep: government intrusion in health care

Policy
November 19, 2022

The American Medical Association (AMA) would have you believe that the biggest threat to the medical profession is “scope creep” – the intrusion of advanced practice providers into medical practice.

The way I see it, this is no big deal; the movement will reach equilibrium, and everyone will play nicely in the sandbox.

In my opinion, the biggest threat to the medical profession is “political creep” – the increasing government …

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It is time that medical societies acknowledge that pro-life views are legitimate

Policy
November 19, 2022

The recent Dobbs decision has led to strong reactions from many major medical associations arguing that limiting abortion options will significantly harm women with unexpected pregnancies. This needs to be acknowledged, and the desire to do what is best for women is to be commended and shows a true passion for providing what these organizations deem to be the best possible care.

However, there are many medical providers who are as …

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Meet the doctor who had a colonoscopy without anesthesia [PODCAST]

Podcast
November 18, 2022
YouTube video

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“If you did not have a colonoscopy, I would still recommend that you do it in a conventional way and get that IV sedation. But if you are an adventurer as I am, I would highly recommend …

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Digital philosophy: a critical tool for the mental health of children

Physician
November 18, 2022

The precipitous decline in the mental health of U.S. children and adolescents has been meticulously cataloged in newspaper articles, books, and documentaries. In our own pediatrics clinic, the numbers have skyrocketed — a baseball player unable to get out of his car for practice, a teenager with aggressive behavior masking underlying depression and anxiety, and another 9-year-old unable to attend school due to daily panic attacks. Every day now, we …

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Why we should end gendered titles

Physician
November 18, 2022

The question of addressing physicians by name has been addressed again. Yet the question about names has not been addressed.

Before addressing the name question, I will talk about how I have evolved with time.

In India, I have been used to formally addressing everyone as either “Sir” or “Madam” during in-person meetings and in virtual communications when I have known them — “Sir/Madam” or rarely …

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I saved a baby’s life

Physician
November 18, 2022

I saved a baby’s life today.

I say that not to impress anyone or to make myself out to be some kind of deity but because it is simply true.

A three-week-old baby arrived at my office, gray and limp, with agonal respirations and oxygen saturation of 67 percent. My team of dedicated office staff worked with me rapidly and seamlessly, providing oxygen, bag-mask ventilation, and emergency medical services (EMS) activation. Together, …

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Why you should add advance directives to your college freshman’s checklist [PODCAST]

Podcast
November 17, 2022
YouTube video

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“Suppose you’re getting ready to send your young adult off to college for the first time. In that case, you’ve likely been spending the summer getting college dorm and apartment essentials lined up: bedding, storage cubes, first …

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Leaving The House of God

Physician
November 17, 2022

To paraphrase Fat Man’s Law Number Three, “At a code, the first pulse you take is your own.”

Enduring advice, as true today as it was in the early ’70s when Roy G. Basch, MD, and his gang of hapless interns roamed the airless wards of The House of God, the mythical hospital in the infamous novel by Samuel Shem, although almost everything else about practicing medicine seems …

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It’s time for a reckoning in pain medicine

Conditions
November 17, 2022

More than a million Americans have died since the late 1990s from drug overdoses, with the vast majority dying from an opioid overdose. This trend started with the heavy marketing of opioids to physicians as nonaddictive and effective. The number of deaths from overdose has escalated significantly in the past few years. Although many of the recent opioid-related deaths are from fentanyl, substance abuse treatment providers report that …

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The story of a physician, after a year sober

Physician
November 17, 2022

My first COVID vacation last year was spectacular, except that I barely remember three days because I was drinking to the point of amnesia.

I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice.   As an adult, I …

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My 5-minute conversation with a suicide hotline expert

Physician
November 17, 2022

Sandy was sent to me by her primary care physician for evaluation of anemia. As I reviewed her chart, I explained to the medical student that the blood work showed a lifelong benign condition called alpha thalassemia trait that she was born with. It had no potential to harm her. This would be a quick consult, meaning we would have some extra time to enjoy our lunch.

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What it means to leave clinical medicine [PODCAST]

Podcast
November 16, 2022
YouTube video

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“Not too long ago, a circumstance occurred. I have experienced similar circumstances several times in my career. However, this time, my response was different. It was like a switch in my brain flipped. I was ready to …

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Integrated care is the key to optimizing cancer outcomes

Meds
November 16, 2022

The American Cancer Society released its annual report on cancer statistics, showing that we have made clear and significant progress in treating numerous forms of cancer. The overall rate of death has declined steadily since 1991, translating to over 3 million lives saved.

Despite this progress, I still see room for improvement in a care model where patients too often slip through the cracks.

The National Cancer Institute identified that …

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Let’s focus more on caring, rather than coding

Physician
November 16, 2022

Risk adjustment is a statistical method used by health plans to predict an individual’s use of health care services and the associated cost of care. Unlike traditional fee-for-service Medicare, Medicare Advantage (MA) plans receive a flat monthly payment for the individual beneficiary’s cost of care, with payments partially based on risk score.

Higher risk scores mean higher payments, and plans have financial incentives linked to more thorough documentation (coding) of their …

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Design thinking in health care: Physicians already have the training to be innovators

Tech
November 16, 2022

Compared to the Silicon Valley world of moving fast and breaking things, health care change often happens slowly. Some of the reasons for the inertia of our industry make sense. Change impacting patients requires a vetting process to ensure we are creating net benefit.

But this inertia also exists partly because many believe our field is so uniquely complicated that it cannot be improved using lessons from other industries. But the …

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Common open enrollment considerations for doctors

Finance
November 15, 2022

Similar to most financial topics, benefit elections are not a one-size-fits-all recommendation. Open enrollment occurs at the end of each year and remains open for a month and a half. During this time, you can sign up for health insurance, flexible spending accounts (FSA) for health care and/or dependent care, health savings accounts (HSA), retirement plans, as well as other benefits. Be aware that employers often use the open enrollment …

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