A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.
Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …
Hospitals taking over private practices
by Sujatha Prabhakaran, MD
Suicide is arguably the most preventable cause of death. It is also a tough thing to talk about. But talk we should, because suicide costs Americans a lot. In 2000, self directed violence cost $1 billion in medical costs and $32 billion in lost productivity. Self-directed violence affects men and women of all racial/ethnic groups. However, as highlighted in the 2011 …
Mental illness in men, and how physicians can prevent suicide in males
Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.
This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is …
Successfully appeal an insurance company reviewer decision
I believe primary care docs are rebelling against the system. The system has made primary care physicians suffer emotionally and financially. The system has taken the greatest form of medical care – that consisting of continuity, comprehensiveness, complexity and completeness – and denigrated it.
Now I talk about “the system” in an anthropomorphic sense, but “the system” is virtual. “The system” has no conscious, it is not deliberate, rather it represents …
Primary care physicians are rebelling against the system
Friday in my office is like happy hour for the oldest of the old.
They come. 90, 95, 100. Always on Fridays. Some come in wheel chairs. Others walking. Some alone. Others with family. 5,6, 7 sometimes even more in just one short morning. And we talk about life, about their children, about growing old. I apologize that at that age I really have little to offer. After all, they know …
Entering the golden age of hospice care
In February, IBM supercomputer Watson won Jeopardy! against its two human opponents, Ken Jennings and Brad Rutter.
Watson’s victory rests on its power in speech recognition and the ability to understand colloquial human language used in game shows like Jeopardy!. The most interesting development of this story is that after Watson’s celebrated win on national television, IBM will partner with Nuance Communications to explore how Watson could help with medical diagnosis …
Welcome our new (doctor) computer overlords
Last weekend I had the privilege of supervising University of Miami Miller School of Medicine students at a free public health screening in Pompano Beach, Florida. The screening was sponsored by the medical school, with the assistance of community leaders, and held in a local public school. The program organization, recruitment of student and faculty volunteers and management of the program was undertaken and implemented by the students. It is …
Free health screening: A service to our community’s health
by Stella Safo
It is Saturday night at an Emergency Department (ED) in Boston, MA and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old gunshot victim or work with the ED docs to assess whether a 59-year-old woman is having an acute stroke?
That is exactly what …
Learning to love primary care via an emergency department rotation
Lack of sexual interest is the most common sexual complaint in women.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which defines psychiatric disorders, defines Hypoactive Sexual Desire Disorder (HSDD) as ‘‘persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity’’ that causes ‘‘marked distress or interpersonal difficulty.’’ Epidemiologic surveys have suggested that from 25 to 50 percent of women report prolonged periods …
Lack of sexual interest is the most common sexual complaint in women
As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even …
Requests for OTC prescriptions for a FSA burdens primary care
If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice.
I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights …
Understand the medical economics of a primary care practice
As far as my chemo nurse Olga (not her real name) is concerned, I can do nothing right.
She scolded me for sending an e-mail when she thought I should have called and vice versa. She scolded me for going home before my next appointment was scheduled. She scolded me for asking to speak to her personally instead of whichever nurse was available. She scolded me for calling my oncologist directly. …
Sharing information about your health with specialists is difficult
Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.
Most can accept it when we’re treated with modesty and respect. But not many are prepared for those times when you might be unnecessarily exposed or treated rudely. The possibilities for embarrassment are endless and it is usually unexpected. When avoidable incidents do happen, most patients are not prepared to speak up. Many …
When your privacy is violated in the doctor’s office
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by Aditya Mattoo, MD
Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking …
Is alcohol good for me? The data behind drinking and your heart
by Zakari Tata, MD
Informed consent has continued to generate a lot of interest in medicine worldwide.
The reason is because patients in medicine and subjects in clinical trials need protection from the multitude of injuries and harms that have been caused by intentional or accidental actions. The controversies generated by various lapses of informed consent, in my opinion, have not been addressed and more safeguards need to be put in place …
A balanced approach to informed consent
Here’s a true story from the operating room:
Surgeon: Intern, what is the story behind this patient?
Resident Intern: Patient is a 51 year old female with breast lump on the left side, and 17 out of 20 lymph nodes positive for cancer.
Surgeon (speaking in a rather ‘as a matter of fact’ tone): Oh, she’s F_ _ _’d.
Resident Intern: shocked, frozen and unable to respond.
“How do some physicians become so stoic?” I …
Physicians who are able to feel compassion
One of the stories circulating regarding the demonstrations in Wisconsin is the authenticity of the doctor work notes.
Squarely in the cross-hairs are physicians from the University of Wisconsin’s Department of Family Medicine.
According to this excellent piece in The Atlantic by physician-writer Ford Vox,
In videos breathlessly presented throughout the conservative mediasphere this weekend, doctor after doctor is videotaped writing patently fraudulent sick notes so that the protesting teachers (whose contracts …
Physicians disgrace the University of Wisconsin with fake doctor notes
How important is a doctor’s skill in the physical examination of a patient?
To the lay person, a doctor’s examination might seem really important. “Of course it is, Dr M … Come on.”
But is it so? Or, perhaps, is the examination a charade, a show, a necessity to complete the medical record.
It turns out that many in the profession think doctors may be losing the skill of palpating and listening. At …
How important is a doctor’s skill in the physical exam of a patient?
Revenue Cycle Management. What does it mean? In a nutshell, it means taking steps to assure that you get paid for what you do and that you get paid in a timely fashion.
The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient’s name, phone number, and maybe the name of their insurance company.
The cycle ends when the balance on their account …
Revenue cycle management for your physician practice
Consumer Reports recently released a survey of both patients and primary care doctors, regarding their perceptions of each other.
Some interesting findings, as summarized by the WSJ’s Health Blog:
On the issue of respect and appreciation, 70% of doctors said they were getting less of it from patients than when they started practicing. For patients, meantime, the more they reported being treated respectfully and listened to, the more satisfied they were …
How patients and doctors can improve the primary care office visit
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