Post Author: John Schumann, MD

Doctor owned hospitals: Are the rich getting richer?

Policy
May 14, 2013

It was bound to happen.

By “it,” I mean that the small group of specialty hospitals (usually orthopedic or cardiology-focused) across that country that are owned by doctors were going to have their “See! We Told ‘ya so!” moment.

Doctor-owned hospitals. How many are there? Two hundred and thirty-eight of them in the whole country (out of more than five thousand)–somewhere between four and five percent of the total in the U.S. (numbers courtesy …

Read more…

The New York Times didn’t kill this patient

Physician
March 20, 2013

A loyal reader sent me a doctor-written column with the provocative headline, “My Patient, Killed by The New York Times.”

First, keep in mind that the website that posted this, Mediaite, is all about the media covering (really fawning and dishing) itself. The purpose of this story, with its provocative headline, sad outcome, and mea culpa tone, is to generate “buzz.”

Then understand that this is a story of one patient who made …

Read more…

Let no broken hip go unfixed: When a surgeon fails to communicate

Physician
March 10, 2013

She was 94-years old with advanced Alzheimer’s. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip.

She’d fallen at her assisted living facility. It was the second time in as many months. She’d broken her collarbone on the previous occasion.

Over the past year, she’d lost 30 pounds. This is natural in the progression of …

Read more…

Filling out a death certificate: A better way is needed

Physician
February 22, 2013

I’ve always had nagging doubts about filling out death certificates.

An excellent article in American Medical News explores the “inexactitude” of the custom.

Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief medical examiner for Fulton County, GA:

Training is a big problem. There are very few medical schools that teach it,” he said. “For many physicians, the first time they see it is when …

Read more…

Concierge medicine: Winners and losers

Physician
December 10, 2012

By now you’ve probably heard of the concept of “concierge medicine.”

To me, it’s an idea that’s Win-Win-Lose:

Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of  charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge …

Read more…

The fine line between gaming the system and maximizing documentation

Tech
November 12, 2012

Does your doctor use a computer instead of a paper chart?

Chances are that she does. The rate of adoption of electronic medical records (EMRs) over the last three years has been very steep.

The main driver of this is a government subsidy from a part of the 2009 Stimulus Act (called the HITECH Act) that incentivizes doctors and hospitals to make the conversion to electronic record-keeping.

The push has been …

Read more…

Companies should not scare us to sell unnecessary screening exams

Physician
November 2, 2012

A patient I’ll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a “mild” blockage in her carotid artery. They told her to discuss it with her primary care doctor (me).

You may have seen the advertisements in your local paper, or even on your local …

Read more…

Having our own doctor treat us in the hospital is a thing of the past

Physician
October 19, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

Read more…

Digital medicine: Patients are stuck in the precarious middle

Tech
October 15, 2012

The use of computers in everyday medical practice has finally reached the tipping point.

The HITECH Act, part of the 2009 federal stimulus bill, has been the final kick in the pants that U.S. health care has long needed to make the conversion to digital. The act states that, by employing electronic health records (EHRs) in a fashion known as meaningful use, doctors are individually eligible for …

Read more…

Why is there a primary care shortage?

Policy
September 28, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance, provided neither the Supreme Court nor a new president overturns the law. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform …

Read more…

Workers’ comp: The dark corner of medicine

Physician
July 23, 2012

An article in the New York Times sheds a little light in a dark corner of medicine, the world of workers’ compensation. In particular, it highlights a world of doctors that dispense drugs in their offices, which improves both patient satisfaction and profits.

Though fraudulent insurance claims are always easy headline-grabbers, the real world of workers’ comp is complex and not always so tailor-made for sound bites.

Add to this …

Read more…

When patients need to find a new equilibrium

Physician
July 18, 2012

Chico (all identifying information removed) was a patient we cared for in the hospital.

Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis.

From my point of view–an instructor teaching residents and medical students–there were two key questions about Chico:

1. What caused his kidneys to fail?

2. Given his kidney failure was “acute,” was there any chance that it’d be reversible? Could Chico’s kidneys heal to the point where …

Read more…

Does leaving against medical advice stick patients with a bill?

Physician
March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

Read more…

ADVERTISEMENT

Is it necessary for a doctor to examine you on each visit?

Physician
March 5, 2012

A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.

Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.

Many pundits have weighed in on whether the …

Read more…

Cost denies an undocumented immigrant a kidney transplant

Physician
January 8, 2012

You’re in your 30s. You work hard. You strive to master your craft. You support your extended family. You are liked by both your co-workers and boss.

Problem: You unexpectedly become unhealthy–you find out your kidneys are failing.

Solution: Regular kidney dialysis can keep you alive, by filtering toxins out of your blood.

Problem: Dialysis is time consuming (>3 hours/session, 3 sessions/week) and leaves you feeling tired and weak.

Solution: Your brother, who is …

Read more…

Young doctors don’t see value in primary care careers

Physician
December 5, 2011

In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.

At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.

For those that don’t choose a subspecialty, one choice remains: traditional …

Read more…

What doctors can learn from the orthodontist’s office

Physician
November 1, 2011

I took my daughter to the orthodontist last week to get braces.

There’s a lot about the process that seems better than when I was a kid. Mostly, it’s that instead of having to slide brackets around each of your teeth (yishk!) the orthodontist just paints a special glue on the enamel and places the brace on the front of each tooth. Kids get to pick the color of their braces …

Read more…

Telemedicine to augment the patient encounter

Tech
September 8, 2011

When I use the term “telemedicine,” what does it mean to you?

In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think “outsourcing” where the radiologist could even be as far away as India.

But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat …

Read more…

The effect of the RUC overvalues procedural skill

Policy
September 2, 2011

An interesting legal case brewing in the medical world that’s worth sharing.

A group of six physician plaintiffs from Georgia are suing the government (the Secretary of Health and Human Services) in a federal district court claiming damages from the fact that Medicare, the massive program that covers the elderly and disabled, fails to execute due diligence by rubber-stamping a reimbursement structure that overvalues procedural medicine over cognitive services.

Huh?

Some background …

Read more…

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 …

Read more…

3
pages