How can patients accept cash-based practices?

Physician
June 22, 2016

A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t.

I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I …

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Don’t do these 5 things with your medical school personal statement

Education
June 21, 2016

Your medical school personal statement is one of the most important components of your application. This short essay can be the deciding factor as to whether or not you will spend the remainder of your life practicing medicine.

To be honest, most personal statements will be similar enough that they’ll fit right in with the rest. There will be a handful that stand out above the majority, and if you can …

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When doctors and patients secretly record each other

Physician
June 20, 2016

A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, “the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any …

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This doctor was remembered for his devotion to patients. Was it enough?

Physician
June 12, 2016

Recently I attended the funeral of a prominent gastroenterologist in my community whom I knew socially as the father of my son’s friend. It was an untimely and rapid death due to pancreatic cancer. He left behind a young wife and four children, two of whom are in college. I would see him periodically at school functions; he would sneak into an event at the last minute and often struggle …

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Physicians are society’s scapegoats

Physician
June 12, 2016

Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …

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7 tips for doctors to be successful in telemedicine

Physician
June 11, 2016

In early 2014 I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then I have worked with several telemedicine platforms. I use telemedicine to keep up my outpatient skills. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider.

Here are my top 7 tips for deciding which telemedicine company to work …

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The story of a man who did not feel well

Physician
June 9, 2016

Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew …

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The question doctors should ask before ordering a test

Physician
June 8, 2016

Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.

Why do doctors over order? These same people thought a …

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Are you the physician who yells?

Physician
June 7, 2016

I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician “Dr. Barkus Yellby.”  Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated …

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Physicians as innovators: 6 ways we help and hurt ourselves

Physician
June 6, 2016

The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …

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MKSAP: 32-year-old man with a rash on his face and midchest

Conditions
June 4, 2016

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

A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well.

Medical history is significant for a recent diagnosis …

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How marriage affects men’s colonoscopy rates

Conditions
May 31, 2016

Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.

More recently, a study published in the journal Preventive Medicine found that married men are …

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Thinking of starting a cash-based practice? Here are the pros and cons.

Physician
May 25, 2016

As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.

Most people …

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Maybe it’s time to go back to index cards for medical records

Physician
May 25, 2016

During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child.  Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity.  His family physician pulled out the index card that served as this man’s medical record.  Yes, you read that correctly.  It was not a chart or computer printout; rather a 4 x …

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The enemy is not death. The enemy is needless suffering.

Physician
May 24, 2016

Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it.   Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain.

The 92-year-old patient is bleeding into her head, but has blood …

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Foreign medical graduates get a raw deal. Here’s why.

Education
May 23, 2016

On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school).

Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even …

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What I learned after 41 years of practicing psychiatry

Physician
May 22, 2016

Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years.

1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I …

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