John Schumann, MD

Articles, page 2

June 19, 2013Jun 19, 201313

Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall. Her son wanted…

Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within …

Health policy

Doctor owned hospitals: Are the rich getting richer?

John Schumann, MD

May 14, 2013May 14, 20137

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…

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 …

Physician voices

The New York Times didn’t kill this patient

John Schumann, MD

March 20, 2013Mar 20, 201311

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…

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 …

Physician voices

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

John Schumann, MD

March 10, 2013Mar 10, 201342

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.…

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 …

Physician voices

Filling out a death certificate: A better way is needed

John Schumann, MD

February 22, 2013Feb 22, 20139

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…

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

…

Physician voices

Concierge medicine: Winners and losers

John Schumann, MD

December 10, 2012Dec 10, 201223

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…

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…

Concierge medicine: Winners and losers

Health technology

The fine line between gaming the system and maximizing documentation

John Schumann, MD

November 12, 2012Nov 12, 20126

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…

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 …

Physician voices

Companies should not scare us to sell unnecessary screening exams

John Schumann, MD

November 2, 2012Nov 2, 20123

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…

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 …

Physician voices

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

John Schumann, MD

October 19, 2012Oct 19, 20123

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…

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 …

Health technology

Digital medicine: Patients are stuck in the precarious middle

John Schumann, MD

October 15, 2012Oct 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…

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 …

Health policy

Why is there a primary care shortage?

John Schumann, MD

September 28, 2012Sep 28, 201239

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…

Why is there a primary care shortage?

Physician voices

Workers’ comp: The dark corner of medicine

John Schumann, MD

July 23, 2012Jul 23, 20123

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…

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 …

Physician voices

When patients need to find a new equilibrium

John Schumann, MD

July 18, 2012Jul 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…

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 …

Physician voices

Does leaving against medical advice stick patients with a bill?

John Schumann, MD

March 8, 2012Mar 8, 201211

(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…

(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 …

Physician voices

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

John Schumann, MD

March 5, 2012Mar 5, 201234

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…

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 …

Physician voices

Cost denies an undocumented immigrant a kidney transplant

John Schumann, MD

January 8, 2012Jan 8, 201218

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…

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 …

Physician voices

Young doctors don’t see value in primary care careers

John Schumann, MD

December 5, 2011Dec 5, 201113

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…

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 …

Physician voices

What doctors can learn from the orthodontist’s office

John Schumann, MD

November 1, 2011Nov 1, 201112

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…

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 …

Health technology

Telemedicine to augment the patient encounter

John Schumann, MD

September 8, 2011Sep 8, 201111

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…

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 …

Health policy

The effect of the RUC overvalues procedural skill

John Schumann, MD

September 2, 2011Sep 2, 20112

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…

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 …