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To put patients’ interests first, we have to put our own aside

Allan Joseph

Policy

November 23, 2013

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …

Don’t resign your professional license in the midst of an investigation

George F. Indest III, JD

Physician

November 23, 2013

Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following.

First, you should never voluntarily relinquish or resign your license after you know …

Going the extra mile for patients: How friendly is too friendly?

Claire McCarthy, MD

Physician

November 22, 2013

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …

What is the best metric to measure a hospital?

Michael Cetta, MD

Policy

November 20, 2013

If you had to pick a single metric to a measure a hospital, which would you choose?

Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …

The focus on patient satisfaction is enough to make you sick

BirdStrike, MD

Physician

November 19, 2013

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All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …

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 …

Read more…

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 …

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