Primary Care

Billing an established patient visit as a consultation

Physician

November 13, 2011

Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).

In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all. Let’s just use this understanding as the brief background for what I’m about to say.

I …

Let’s stop degree creep in health care

Sharon Bahrych, PA-C, MPH

Physician

November 8, 2011

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist. And for the nurse, unless they have RN, BSN or RN, MSN after their name …

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Let’s stop degree creep in health care

Neuropsychologists in the evaluation of ADHD

Dominic A. Carone, PhD

Conditions

November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

What happened to the art of medicine?

Sharon Bahrych, PA-C, MPH

Physician

November 2, 2011

During our medical training we are taught to use evidence based medicine. This means using the most up to date scientific research data that has been analyzed and accepted as fact. But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not. For this would mean we would only be following half of medicine. The art of …

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What happened to the art of medicine?

Three major cognitive errors physicians make

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

Honesty between doctors and patients goes both ways

Stewart Segal, MD

Physician

September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

When professional courtesy could get physicians in trouble

Deniza Gertsberg, Esq

Physician

September 18, 2011

More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.

To be sure, not all professional courtesy discounts or free …

False assumptions and clinical errors in modern medical practice

George Lundberg, MD and Clifton Meador, MD

Physician

September 18, 2011

Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:

1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.

2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.

3. Lack …

How your physician is like a chef

Stewart Segal, MD

Physician

September 17, 2011

I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.

Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My …

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How your physician is like a chef

When not to use a physician recruiter

Bo Claypool

Physician

September 11, 2011

As a physician recruiter of prominence, a number of times during any given week I get a fair number of calls from physicians in training who, honestly, should not be calling me whatsoever and I am very frank in telling them this. The call normally starts something like this:

“Hi Bo, my name is Dr. Doe. I am finishing up my dermatology residency and I want to be there in …

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When not to use a physician recruiter

10 ways to make a difference in the lives of your patients

Jan Gurley, MD

Physician

September 5, 2011

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

What do tonsils do and why would we take them out?

Christopher Johnson, MD

Conditions

August 19, 2011

There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …

Female doctors and the physician shortage

Darrell E. White, MD

Physician

August 13, 2011

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.

In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …

6 reasons why doctors won’t call patients back

Mary Pat Whaley

Physician

August 12, 2011

Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.

1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …

When specialists try to practice primary care

Juliet K. Mavromatis, MD

Physician

August 5, 2011

Recently a good friend asked me to recommend an excellent primary care physician in New York City. When no one immediately came to mind, I asked a couple of doctor-friends who trained in New York. One friend, a cardiologist, gave me two names—one was a rheumatologist, who also practices general medicine, and the other an infectious disease doctor by training. My initial reaction to my cardiologist friend’s suggestion that …

Planning effective office meetings for your medical practice

Rosemarie Nelson

Physician

July 30, 2011

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make …

Physicians who treat inmates are at greater risk of litigation

Jeffrey Knuppel, MD

Physician

July 29, 2011

Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?

Yes, in most cases I think it is.

It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give …

How a doctor learned how to suture

Fizzy, MD

Physician

July 27, 2011

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …

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How a doctor learned how to suture

Why receptionists are integral to the health care team

Kevin Pho, MD

KevinMD

July 25, 2011

Health care is a team sport, and one of the most important members is the office receptionist.

Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.

In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …

The role of non-physician clinicians in primary care

Cedric Dark, MD, MPH

Physician

July 22, 2011

With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.

The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …

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