Here’s what’s wrong with time-based billing in the hospital

Physician
April 17, 2018

Consider this hypothetical addendum to a hospital discharge summary:

”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact …

Read more…

Independent practice: Nurse practitioners respond

Policy
April 17, 2018

Shortly after the publication of “Independent practice: Both nurse practitioners and physicians should be outraged,” the nurse practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.”

But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support …

Read more…

The human touch in medicine: good or bad?

Physician
April 17, 2018

Humans need human touch

Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.

However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in …

Read more…

The fall of the digital rectal exam

Conditions
April 16, 2018

For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.

As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …

Read more…

Sexual assault in the emergency department: What can you do?

Physician
April 16, 2018

It has been documented that 1 in 3 women will experience rape in her lifetime, and this is most common in women under the age of 25.  Over 95 percent of victims of sexual assault are women worldwide, while in North America estimates place that at 85 percent.  These are the assaults we know about — generous estimates say that, at most, 10 percent of rapes are reported to police …

Read more…

Reflections on school violence: a psychodynamic perspective

Conditions
April 15, 2018

The mental health community must increase its clinical acumen regarding complex psycho-pathology consisting of the avoidant personality, social impotence, and related rage. School violence has taken on epidemic proportions since two disturbed adolescents masterminded Columbine and became role models for the mentally ill young men who drive the new culture of school shootings.

While the profile of the school shooter has evolved over the last couple of decades, it’s worth considering …

Read more…

Emergency physicians are glorified secretaries with medical degrees

Physician
April 15, 2018

We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …

Read more…

11 physician finance lessons from The Greatest Showman

Finance
April 15, 2018

I love movies. Not the artsy types that win awards; I most enjoy the big, expensive popcorn blockbusters that take you away to a different time and place. However, as our income and wealth has grown, we’ve maintained a few of our “cheapskate” habits from when we were poor. One of these is we see almost all of our movies at the “dollar theater,” a second-run theater where the entire …

Read more…

America leads the world in high tech care and health care costs

Policy
April 14, 2018

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is …

Read more…

Push back on toxic behaviors from other doctors

Physician
April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

Read more…

Physicians and medical students: Unlearn helplessness

Education
April 13, 2018

Learned helplessness. It’s a psychological concept marked by a perceived loss of power, and it’s prevalent in medicine. We are taught early on how little we are in this colossal world. We are told what to do, when to do it, and what we will get for it. Our objections go unheard or—worse—ignored.

Let me quote a paragraph from The Paradox of Choice by Barry Schwartz:

They were conducting a series of experiments on basic …

Read more…

Do whatever it takes to have fun and spend time with your family before it is too late

Finance
April 13, 2018

Recently I had three important events happen during a three day period that reminded me of the brevity of our life and the need to live life to the fullest every day.

On July 4th, having planned celebratory events that day with friends and family, a CRNA in my home town awoke feeling poorly just before sun up. He was in great health the day before and lived a very active …

Read more…

Financial independence: the story of the 3 brothers

Finance
April 12, 2018

There was once three brothers who set off on the journey of a lifetime by embarking on three separate roads.  Each brother was uniquely different, and quickly these roads diverged.

It was believed that the eldest brother was most wise because his path was clear and straight.

The middle brother was a strong walker but easily distracted.  It was hard to keep him concentrated on the task at hand.

And finally, the youngest …

Read more…

ADVERTISEMENT

How physicians dress matters. Here’s why.

Physician
April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

Read more…

A physician thanks those who made her who she is today

Physician
April 11, 2018

To the intern on the trauma surgery service when I was a medical student: Thanks for occasionally wearing leather pants to work. Thanks for smiling and having a sense of humor despite having to round on thirty patients. Thanks for teaching us medical students while running a significant sleep deficit.

To the internal medicine resident who wanted to become a cardiologist: Thank you for indulging me and telling me how you …

Read more…

What happens to the kids of child abuse when they grow up?

Physician
April 11, 2018

As he sat in the driver’s seat and started to whistle that dreaded Willie Nelson song, my heart started racing, and my world started to spin. While most kids may be annoyed hearing their father whistling that toneless noise, terror started seeping into my very bones. I knew what that sound meant and it was no Pavlovian response, but rather a foretelling of the horror coming. Simply put, it meant …

Read more…

First date with a medical student

Education
April 10, 2018

Her: “So what do you do?”

Him: “Well, I’m applying to medical school. If I make it, I’ll spend the vast majority of my time studying for the next four years. You and I will be able to go on cheap dates occasionally, but even then I’ll feel guilty about not studying. I won’t have any money, so you’ll have to support me on your income. Otherwise, I’ll have to take …

Read more…

Why cataract surgery is more complicated than it should be

Policy
April 9, 2018

Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.

Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.

Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, …

Read more…

Why your physician wellness programs aren’t working

Physician
April 9, 2018

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

Read more…

Public vs. private medical school: Which should you choose?

Education
April 9, 2018

It’s a question that reverberates in the minds of premeds around the country.

If you have a choice between multiple medical schools, should you go to the cheapest medical school available, or should you go to the more prestigious, more expensive medical school?

MD vs. DO vs. Caribbean

I think it is worth the investment to go to a U.S. allopathic (MD) school if at all possible.

It’s an unfair bias, because every medical …

Read more…

611
pages