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Why physicians are hesitant to take Medicaid patients

Peter Ubel, MD

Policy

November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

How to know whether antidepressants will help

Elana Miller, MD

Meds

November 18, 2013

It seems to be trendy these days to say we’re all overmedicated. People say we swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.

However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …

Boxer at Rest: A physician’s interpretation

Jeffrey M. Levine, MD

Physician

November 16, 2013

Boxer_02

Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …

Asthma in children: A complete primer

Christopher Johnson, MD

Conditions

November 15, 2013

Asthma is a common problem in children — nearly 10% now have it — and the number is increasing. Researchers are not sure of the reasons for this steady increase, but decreased air quality, lower activity levels among children, and an increase childhood obesity have all been implicated. Whatever the cause, it means that millions of American children take medicine for asthma. A significant number of these children end up in …

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Asthma in children: A complete primer

Doctors need to remember that they need to be human first

David L. Katz, MD

Education

November 14, 2013

In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.

I distinctly recall the time in my medical education when I realized I was becoming more medical …

The outrageous ER markup for a tetanus shot

Olivier Van Houtte

Conditions

November 13, 2013

In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.

In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …

3 words that define a philosophy of care

Rob Lamberts, MD

Physician

November 12, 2013

To what end?

Those three words have become something of a mantra, a mission, a philosophy of care.

To what end do I prescribe a medication?
To what end do I make a diagnosis?
To what end do I order tests?
To what end am I documenting?
To what end is there a patient record?
To what end do I send a person to a specialist?
To what end do patients need to come to see me in …
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3 words that define a philosophy of care

Understanding the intersection of health care and social services

Elizabeth H. Bradley, PhD and Lauren A. Taylor, MPH

Policy

November 10, 2013

Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances — layoffs, foreclosures, accidents, violence — can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of …

How a letter of intent can help with physician recruitment

Bo Claypool

Physician

November 9, 2013

As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.

While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document …

How to respond to a Medicare audit: 17 tips from a lawyer

George F. Indest III, JD

Policy

November 9, 2013

Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.

Having too many claims for level five CPT codes …

What happens to us when we lie about dying?

James C. Salwitz, MD

Physician

November 8, 2013

It is in our nature to lie. Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication. What happens …

How can we reduce friction in the hospital?

Leslie Kernisan, MD, MPH

Physician

November 7, 2013

Why aren’t people in hospitals more attentive to the needs of patients?

In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha …

Who’s in control? Why both doctors and patients are frustrated

Shirie Leng, MD

Physician

November 6, 2013

I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”

This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …

Solving the weekend effect for patients in the hospital

Robert Pearl, MD

Physician

November 6, 2013

If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?

It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …

JAMA removes cover art, and why that matters

Jeffrey M. Levine, MD

Physician

November 6, 2013

JAMA_beforeafter1a

Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …

Should smokers pay higher health insurance premiums?

Carol Duh-Leong

Policy

November 4, 2013

While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …

What does it mean to be a medical intern?

Brian J. Secemsky, MD

Education

November 3, 2013

Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …

A physician expert witness speaks out

Anonymous

Physician

November 2, 2013

I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with …

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A physician expert witness speaks out

Why insurance is the wrong model for health care

Paul Laband, MD

Policy

November 2, 2013

Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.

Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …