The challenge of pre-authorization for an elective procedure

Policy
June 27, 2011

by Grayson Wheatley, MD

It was supposed to be a routine office visit for my patient.

Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …

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The challenge of pre-authorization for an elective procedure

Reasons why medical students burn out and become depressed

Education
June 27, 2011

As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought.  I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over …

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Reasons why medical students burn out and become depressed

New fields in general surgery and the rise of the surgical hospitalist

Physician
June 24, 2011

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

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New fields in general surgery and the rise of the surgical hospitalist

Reasons why your doctor is running late

Physician
June 24, 2011

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim.   It’s not enough any more to wear a bullet proof white coat.  …

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Reasons why your doctor is running late

Difficult testing decisions for parents with premature babies

Physician
June 22, 2011

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.

When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …

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Difficult testing decisions for parents with premature babies

Hospitalists should limit the number of patients they see

Physician
June 21, 2011

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

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Hospitalists should limit the number of patients they see

Explaining how an EKG works

Conditions
June 21, 2011

What is an EKG?

EKG stands for electrocardiogram.  It should probably and sometimes is abreviated ECG, but EKG seems to have stuck as more popular.

Scientists have known for over 120 years that the heart gives off electrical currents when it beats, but it was the Dutch scientist Willem Einthoven in the early 20th century who discovered the nature of this phenomenon and who developed the electrocardiogram as a tool to …

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Explaining how an EKG works

Why the AMA is in decline, and should doctors care?

KevinMD
June 20, 2011

The American Medical Association recently released its membership numbers, and they’re declining.

According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”

It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%.  But it seems many physicians have little …

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Why the AMA is in decline, and should doctors care?

We want our doctors to be perfect, but they’re human too

Physician
June 16, 2011

Though there are few subjects as immediate to my experience as that described in Gardiner Harris’s article in The New York Times, “More Doctors Say No to Endless Workdays,”  perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn’t feel much need to read the rest of the article.  More doctors say no …

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We want our doctors to be perfect, but they’re human too

Before getting a CT scan, ask your doctor if its really needed

Conditions
June 15, 2011

How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

Looks a bit like a medieval torture doughnut.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in …

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Before getting a CT scan, ask your doctor if its really needed

A history of smallpox in America

Conditions
June 14, 2011

This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.

In 1751, when George …

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A history of smallpox in America

MRI overuse is widespread, and dangerous to patients

Physician
June 13, 2011

MRI overuse and misuse really make me angry.

Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.

MRI is unnecessarily overused. In …

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MRI overuse is widespread, and dangerous to patients

Doctors don’t take snow days

Physician
June 12, 2011

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t …

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Doctors don’t take snow days

The Golden Moment in medical malpractice

Physician
June 12, 2011

As Kevin Pho pointed out in his piece, “How malpractice hurts doctors and their future patients,” physicians who have been through trial are often never quite the same.

Physicians who have been sued in medical malpractice case are often referred to as the “Second Victim,” a term that says it all.   When a mistake is made and a patient is injured, the physician also suffers, often in silence and …

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The Golden Moment in medical malpractice

ABIM Maintenance of Certification (MOC) internal medicine exam tips

KevinMD
June 10, 2011

This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.

7 weeks later, I received my results.  Thankfully, I passed.

This was not entirely a surprise, as the pass rate for first-time test takers was 88%.  But it definitely requires some studying.  It’s not a gimmie.

Considering that I last took my board exam in …

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ABIM Maintenance of Certification (MOC) internal medicine exam tips

A doctor’s letter to a patient with newly diagnosed cancer

Physician
June 9, 2011

Dear “Robin,”

Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease.  As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal.  With you, cancer has invaded our inner circle, and we all share your shock and despair.

No one can know exactly what it feels like …

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A doctor’s letter to a patient with newly diagnosed cancer

Prices should be readily available to save hospitals money

Physician
June 9, 2011

Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.

One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins …

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Prices should be readily available to save hospitals money

Cultural attitudes influence the benefit from stem cell therapy

Meds
June 8, 2011

Embryonic stem cells are present after a fertilized egg divides for two or three days. They have the seemingly miraculous ability to turn into any of the tissue types in the body—whether brain neurons, beating heart cells, bone, or pancreatic islet cells. It is important to understand just where these cells come from.

Those used in science are …

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Cultural attitudes influence the benefit from stem cell therapy

What will be your legacy as a physician?

Physician
June 6, 2011

I’ve heard some physicians wonder out loud if their career has been “wasted” – either because they were on a path that wasn’t a good fit or they spent years focusing on accumulating and worrying rather than on contributing and enjoying. The question is one of personal value:  Am I measuring up? And by whose metrics?

How do you measure the value of your physician career? Dollars earned? Lives saved? Honors …

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What will be your legacy as a physician?

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