When professional courtesy could get physicians in trouble

Physician
September 18, 2011

More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.

To be sure, not all professional courtesy discounts or free …

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False assumptions and clinical errors in modern medical practice

Physician
September 18, 2011

Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:

1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.

2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.

3. Lack …

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How your physician is like a chef

Physician
September 17, 2011

I wear lots of hats.  Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do.  Analogies help people conceptualize the complexities of medicine in a way that makes sense.

Today, I had my chef’s hat on.  I was actually treating a young chef and found myself talking about food and medicine.  There is a direct correlation.  My …

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When not to use a physician recruiter

Physician
September 11, 2011

As a physician recruiter of prominence, a number of times during any given week I get a fair number of calls from physicians in training who, honestly, should not be calling me whatsoever and I am very frank in telling them this.  The call normally starts something like this:

“Hi Bo, my name is Dr. Doe.  I am finishing up my dermatology residency and I want to be there in …

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The graveyard hidden in a surgeon’s mind

Physician
September 9, 2011

This is a difficult story to tell but if I am to be true to the complete experience of a surgeon, I do need to tell it.

One of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. He went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. …

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Human capital makes doctors special

Physician
September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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How a doctor reviews cases for both plaintiff and defense attorneys

Physician
September 7, 2011

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

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Phil Mickelson’s psoriatic arthritis explained

Conditions
September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

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10 ways to make a difference in the lives of your patients

Physician
September 5, 2011

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

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Don’t always blame anesthesia for problems in the OR

Physician
September 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

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Heart valve repair without open surgery

Conditions
September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged  aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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How medical students can prepare to be hospitalists

Education
September 1, 2011

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question.  As …

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Medical students spending time in a nursing home as a patient

Education
August 31, 2011

An interview by Curaspan Health Group with Marilyn Gugliucci, PhD.

Every summer, a handful of medical students spends two weeks in a nursing home as a patient. That’s part of what’s been called “the life-altering education” established by Marilyn Gugliucci, Ph.D., the director of geriatrics education and research at the University of New England College of Osteopathic Medicine.

Gugliucci spoke with Curaspan Connections about the inspiration for her unique approach to elder-care …

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Treating fungal laryngitis in patients with asthma

Conditions
August 31, 2011

It is a big bummer to be an asthmatic. Not only is breathing a problem, but even the treatment for asthma can cause problems.

Take for example steroid inhalers like Advair, Symbicort, fluticasone, etc.

All asthma patients know to rinse their mouth out after inhaler use due to risk of oral thrush, but what about from the back of the mouth down to the vocal cords? This nether region can’t be …

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Properly delete electronic medical records, or face fines

Tech
August 30, 2011

Could a complete stranger receive your echocardiogram results in the mail?

Could a homeless guy in Boston end up with your labs in his shopping cart?

Is it possible that your medical records were sold on eBay?

Yes. Yes. And yes.

On February 24, 2011, Massachusetts General Hospital  was fined $1 million dollars by the federal government when an employee inadvertently left a stack of papers on the subway. These documents contained the …

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Consider half life during drug detoxification

Meds
August 30, 2011

A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.

Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …

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The expensive progression of pill crushing technology

Meds
August 29, 2011

We have to crush pills sometimes.  Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar and pestle.

 

Anyway, this is what we used …

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The ethics of being on a pharmaceutical advisory board

Meds
August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

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Navigating the path of contradictory medical opinions

Conditions
August 24, 2011

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory …

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