My attending doctor (a neurologist) and I were sitting at the nurses’ station discussing a patient who had presented with a seizure when his pager beeped.
“Hold on, I have to call this in”, he said. I listened to snippets of the conversation. “How long has he been like that?” “How far away is the helicopter?” “Alright, let me run to my office and set up my equipment.”
He hung up …
How telemedicine helped a stroke patient
Twitter, like most social media, is evolving rapidly. Even though most physicians are not directly familiar with Twitter, more are building an awareness and curiosity each month. This post is written mostly for those of you new to this tool or giving it consideration.
The AMA recently posted an article entitled Physicians on Twitter and here is a synopsis of their study: “The study focused on 5,156 tweets …
Suggestions for physicians trying to determine the value of Twitter
Danielle and Robb Deaver are living proof of the awful reality of Nebraska’s ill-conceived “fetal pain” law. The law, which took effect last October and is the only one of its kind in America, prohibits abortions in the state after the 20th week of pregnancy. It is based on the discredited notion that a fetus may feel pain at that stage of development. Physicians who break the law face …
Implications of Nebraska’s ill-conceived fetal pain law
As a physician, and as an interventional radiologist, I consult with many patients. Similar to anyone who sees and talks with many people, I encounter a significant diversity of personality types, cultures and attitudes. One thing I have noticed is that each person has a certain level of expectation regarding their care, illness, and our potential interaction.
I have visited with many people who are simply happy to have someone …
What is your expectation when you visit a physician?
In early February, my new patient was a middle-aged woman from here in Silicon Valley with a self-discovered 2 cm right breast mass. Her internist was all over this. She quickly had a core needle biopsy, was evaluated by one of our breast surgeons, and was referred to me for an opinion regarding pre-operative (neo-adjuvant) chemotherapy. I saw her …
ASCO: Making e-visits work for cancer patients
Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.
Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.
Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.
There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven …
What is defensive medicine in obstetrics?
Over the years, I have come to the painful realization that I am not perfect.
Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don’t read this, patients, because you wish even more than I do that I were perfect (especially when I’m operating on you). But it’s true.
Long ago, I remember feeling …
Perfect is the enemy of good when it comes to work-life balance
Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …
Are psychiatrists rushed, uncaring, and in it only for the money?
As a middle-aged physician all too aware of the fact that we are all merely “passing through” life on our way to somewhere else, I am increasingly concerned with having a good work-life balance. Gone are the days of my residency when I was only able to catch a couple of hours of sleep here and there and be lucky to have the time to eat a fast food …
A Physician Family Office for high net worth families
I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in …
Poor, illegible entries in medical notes can cost lives
Every chance I get, I do a grand rounds with pediatricians and other PCPs to promote what you might call Allergy & Asthma 201, and also welcome as many residents as is practical for rotations in my office. The reason is straightforward—I have plenty of new patients who need the specialty care that an allergist can provide — both my accountant and I are happy to have them — but …
How an allergy specialist reaches out to PCPs
A guest column by the American Medical Association, exclusive to KevinMD.com.
Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done.
The AMA’s fourth annual check-up …
AMA: Health insurers’ denial rates are down, but error rates are up
The majority of new job openings for physicians are now as hospital employees, not in private practice.
This is the new reality for both residents facing the employment landscape and seasoned physicians looking for better opportunities. In their 2011 Review of Physician Recruiting Incentives, Texas-based national physician search firm Merritt Hawkins confirmed that private practice scenarios are giving way to doctors being directly employed by hospitals, large health systems, and medical groups.
As …
How the landscape of physician hiring is changing
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In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present. I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful. I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients. …
Implications when technology catches up with medical practice
Skin cancer is the most common kind of cancer in the United States, affecting more than 2 million Americans every year. It is estimated that one in five Americans will develop a skin cancer in their lifetime.
There are three main types of skin cancer. Melanoma is the most serious form of skin cancer, which can be fatal if not treated early. While melanoma accounts for a very small percentage …
The best defense against skin cancer is prevention
Dr. Eric Appelt was born to be a superstar. During his career, he has redefined what it means to be committed to medicine, and he embodies the practice of perseverance on a daily basis. I am proud to say that he is one of my role models as I continue my medical education.
As a young man growing up in Brenham, TX, Appelt was the kind of son every parent …
Eric Appelt and his extraordinary commitment to medicine
I was paged by labor and delivery three times during the 10-minute drive from my house. I headed straight from the parking lot to the labor ward expecting a patient of mine to be close to delivery. I was wrong.
The chief resident and attending obstetrician were waiting. They looked tired and worried.
A woman had arrived on Friday with ruptured membranes. She was 21 weeks along in her pregnancy, and now …
I don’t like that you do abortions, but if you didn’t, I would probably be dead
According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.
A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”
Professionals are …
The professional status of physicians is at risk
Dr. Lewis didn’t sleep last night.
All day he stood, heavy in full surgical scrub with a human heart in his hands, replacing damaged valves and calcified arteries until the heart beat on its own again. After he finished, there were a few hours before the transplant to get some dinner, to call home.
The heart came on a helicopter. A young man, a bad accident, a perfect heart. Dr. Lewis pierced …
Attending physicians who work too many hours need restrictions too
Your staff members are your most important (and costliest) resource. Have you invested in them? Do they know what is expected of them? Have you asked them if they have what they need to do their jobs?
Optimizing staff performance is a process. It starts with a plan, not the formal performance review.
You can’t do a successful performance evaluation without establishing accurate standards against which the employee’s performance can be …
How to review the performance of your office staff
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