Billing an established patient visit as a consultation

Physician
November 13, 2011

Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).

In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all.  Let’s just use this understanding as the brief background for what I’m about to say.

I …

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Why do non-profit hospitals compete with each other?

Policy
November 13, 2011

While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.

But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …

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The new definition for a medical emergency

Policy
November 9, 2011

The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed.  Some 21 states use a variation of the old definition …

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Let’s stop degree creep in health care

Physician
November 8, 2011

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist.  And for the nurse, unless they have RN, BSN or RN, MSN after their name …

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Treating Adele’s vocal cord hemorrhage

Conditions
November 6, 2011

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

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Neuropsychologists in the evaluation of ADHD

Conditions
November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

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What happened to the art of medicine?

Physician
November 2, 2011

During our medical training we are taught to use evidence based medicine.  This means using the most up to date scientific research data that has been analyzed and accepted as fact.  But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not.  For this would mean we would only be following half of medicine.  The art of …

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Doctors are reluctant to have end of life conversations

Physician
November 2, 2011

My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”

Another one of my patients, an …

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How alternative medicine may have killed Steve Jobs

Conditions
October 30, 2011

When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.

As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.

Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.

Would Steve Jobs be alive today had he consented to surgery when they first discovered …

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How a medical student uses an iPad for patient care and education

Tech
October 23, 2011

iPads have been introduced into medical education mostly during the pre-clinical years. I’d like to share my experience using an iPad during my clinical year. I’ve found it to be exceedingly useful and versatile.

I have an entire medical library in my pocket. With the touch of a button I can pull up essential texts such as Harrison’s Principles of Internal Medicine or William’s Endocrinology. I get these books and …

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The problem with round the clock hospitalist coverage

Physician
October 21, 2011

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf.  It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …

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Makes you want to pull your hair out: Treating trichotillomania

Conditions
October 21, 2011

One of the saddest, but more treatable, causes of hair loss in patients is trichotillomania, the impulse control disorder in which a person repeatedly pulls out hair from their body for non-cosmetic reasons. While some people have never even heard of trichotillomania, according to the Trichotillomania Learning Center, as many as ten million Americans (or 4% of the U.S. population) suffer from the disorder.

According to the Diagnositic and Statistical Manual …

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Why radiology is the cornerstone of any hospital

Physician
October 19, 2011

Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …

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tPA is the standard of care for stroke but with significant risks

Conditions
October 17, 2011

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke.  (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …

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The decision not to become a surgeon

Physician
October 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

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The life of a medical resident in Mexico

Education
October 12, 2011

The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is …

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Three major cognitive errors physicians make

Physician
October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

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The decision to pursue a rare illness

Conditions
October 1, 2011

Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.

He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …

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Honesty between doctors and patients goes both ways

Physician
September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?”  I wanted to reply, “No, just be dishonest, I like it better that way!”  “Can I be” implies that, in past conversations, my patient has been dishonest.  Dishonesty is a relationship breaker.  Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

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