David Mokotoff, MD
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Latest articles
Conditions and diseases
The trend of increasing specialization in medicine may lead to unintended adverse consequences. There is an old saying, “We see what we recognize and we recognize what we know.” My wife’s recent adventures in ophthalmic care is such an example.…
The trend of increasing specialization in medicine may lead to unintended adverse consequences. There is an old saying, “We see what we recognize and we recognize what we know.” My wife’s recent adventures in ophthalmic care is such an example. I offer it as a cautionary tale.
She was born with granular corneal dystrophy (GCD). We would later learn that this autosomal dominant gene was thought to have originated in a …
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How tunnel vision can lead to bad medicine
Physician voices
The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit…
The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit rules. Added to that are multiple electronic medical records that need to be implemented, vary from one hospital to another, and often do not “talk” to one another. Thus, it …
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Why doctors don’t like to retire
Physician voices
Although my father did not discover penicillin, he helped do the research showing its effectiveness in curing infective endocarditis. As an internist, he then became enamored with the role antibiotics could play in treating infections. Growing up, my siblings and…
Although my father did not discover penicillin, he helped do the research showing its effectiveness in curing infective endocarditis. As an internist, he then became enamored with the role antibiotics could play in treating infections. Growing up, my siblings and I can attest to his unbridled enthusiasm, as every time we contracted a cold, we would get a shot of the wonder mold in our butts. The fact that colds …
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The unscientific lure of antibiotics
Physician voices
I have now been out of the active medicine for two years. I still have dreams about being a doctor and practice. I don't think you can do the same thing day in and day out for 40 years and…
I have now been out of the active medicine for two years. I still have dreams about being a doctor and practice. I don’t think you can do the same thing day in and day out for 40 years and not have it be a part of who you are. I am still asked my opinion by friends and family about their health issues, and frankly, I find my fund …
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What life is like for this retired physician
Physician voices
It is hard, perhaps impossible, to take the measure of a man in thirty minutes. However, there is still much that can be learned. After enjoying an evening meal in Tampa with friends to celebrate my birthday, my wife and…
It is hard, perhaps impossible, to take the measure of a man in thirty minutes. However, there is still much that can be learned. After enjoying an evening meal in Tampa with friends to celebrate my birthday, my wife and I summoned a Lyft to get home. The ride would be about a half an hour. As is characteristic of the new ride share companies, notably Uber and Lyft, I …
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The kind of person who makes this country great
Drugs and prescribing
Say the words, "drug addiction," and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as "benzos." I should know because after taking…
Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.
About twelve years ago, my father died and then …
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Benzodiazepine addiction is real. This physician shares his story.
Physician voices
For a moment, let's forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not. I would rather, however, look at how…
For a moment, let’s forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not.
I would rather, however, look at how Donald Trump in the White House might affect the day-to-day lives of physicians. And by this I am not referring to his support or opposition to universal health care, for I …
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How a Trump presidency may affect physicians
Physician voices
In 2013, I wrote a post, "How Can Physicians Retire Gracefully?" Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I…
In 2013, I wrote a post, “How Can Physicians Retire Gracefully?” Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I thought it was time to revisit my thoughts and predictions.
I have been able to keep structure to a minimum. I go to tai chi classes two to …
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This physician retired years ago. So how’s he doing?
Health policy
A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by…
A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested
For those who are unaware, “bundled payments” means that …
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Bundled payments means the death of quality medical care
Physician voices
We all accept that we can't vote until we are 18 and can't order alcohol -- at least legally -- until we are 21. We know that if we speed 60 mph in a 45 mph zone, we risk a…
We all accept that we can’t vote until we are 18 and can’t order alcohol — at least legally — until we are 21. We know that if we speed 60 mph in a 45 mph zone, we risk a traffic ticket or accident. We get used to these numbers and pretty much know the risks if we break them. However, the practice of medicine is becoming more and more …
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The practice of medicine is becoming a numbers game
Physician voices
On July 1, 2014, I retired after 35 years in practice. Or at least so it seemed. Before and after retirement, my cardiology group asked if I might be interested in part-time work. At first I said no. Due to…
On July 1, 2014, I retired after 35 years in practice. Or at least so it seemed. Before and after retirement, my cardiology group asked if I might be interested in part-time work. At first I said no. Due to my retirement, a physician’s poor health, and one partner’s departure due to chronic complaints of being overworked and under-appreciated, the group found itself without three doctors. As my retirement approached …
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A retired cardiologist goes back to work. Paperwork greets him.
Health policy
Having just retired on July 1st, my medical group's commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had…
Having just retired on July 1st, my medical group’s commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.
I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has …
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Do patients choose Medicare Advantage for convenience?
Conditions and diseases
This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly…
This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient’s arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is …
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The slippery slope of shorter hospital stays
Health policy
Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency…
Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like …
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What happens in the VA health system matters to all of us
Physician voices
Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital -- ever. (I am retiring from medicine in ten weeks.) I certainly wasn't there for the food, although the fare was much better…
Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital — ever. (I am retiring from medicine in ten weeks.) I certainly wasn’t there for the food, although the fare was much better than the daily servings in the doctors’ lounge. Part of the night’s agenda was a rousing talk by the hospital’s new chief medical officer (CMO). A retired surgeon, the CMO …
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Patient satisfaction: Hospitals are not like car dealerships
Physician voices
I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician's progress note. To be sure, these notes, even…
I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician’s progress note. To be sure, these notes, even the now “ancient” written ones, were far from perfect. And they were often illegible. Shortcuts such as “as above” or AVSS (all vital signs stable) littered the pages of the …
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Death of the physician progress note
Physician voices
Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied…
Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied to medicine as well. Having just turned 65, my financial advisor says from his analysis, I can retire any time now. I have a contract with my cardiology group, which …
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How can a physician retire gracefully?
Health policy
If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array…
If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array of diagnostic information about illnesses, and direct treatment paths.
However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to …
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Why health insurance for all obstructs lowering health care costs
Health policy
A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of…
A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …
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Medicare places hospitals in a discharge conundrum
Health technology
With the recent NSA admission of recording phone conversations of US citizens, there has been renewed interest in the right to privacy. For the record, it is worth recalling what the Fourth Amendment to the Constitution says. "The right of…
With the recent NSA admission of recording phone conversations of US citizens, there has been renewed interest in the right to privacy. For the record, it is worth recalling what the Fourth Amendment to the Constitution says.
“The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported …
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A deal with the devil: The security of electronic medical records
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