Specialty Care

Specialists writing on KevinMD about their practices: what private equity does when it buys a specialty group, from dermatology roll-ups to staffing companies, and whether nurse practitioners and physician assistants belong in every specialty and on what terms. Two maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Honored to care for many priests and nuns in my practice

Michael Kirsch, MD

Physician

May 8, 2011

Our society thrives on tension and competition.

GOP vs Democrats
Civil Libertarians vs Eavesdroppers
Ohio State vs Michigan
Creationists vs Darwinists

Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. …

Fewer choices for patients with health care consolidation

John Mandrola, MD

Health Policy

May 6, 2011

As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.

A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …

Be a boring patient, not an interesting patient

Dr. Martin Young

Patient

May 6, 2011

“She’s a really interesting patient!”

The doctor visiting the lady in question at home is correct. Nothing about her illness either has been routine. The progression of her disease has confounded her regular doctors for months. Nothing about her condition is normal. Medications have not worked as expected. The original diagnosis — Parkinson’s — is in question. All my training and expertise is inadequate, for I am an ENT surgeon, not …

Improving atrial fibrillation communication between doctors and patients

Kevin

Patient

May 6, 2011

by Mellanie True Hills

I have heard from thousands of atrial fibrillation patients who have shared their afib experiences with me. For so many of us, the diagnosis and treatment of afib is confusing and scary.

To improve communication between patients and their health-care providers, and ultimately, provide better care, I recently shared with doctors at the Western Atrial Fibrillation …

Dealing with a negative online review on a physician rating site

Kevin Pho, MD

KevinMD

May 3, 2011

Whenever I speak about social media to doctors across the country, I often get asked, “How do I deal with a negative online review?”

Here’s one way not to handle it: sue the patient writing the review.

There’s a well publicized case in Minnesota, where a resident posted a screenshot of …

A simpler coding system proposal with a focus on primary care

Paul Fischer, MD

Physician

May 2, 2011

In a recent Wall Street Journal article, Barbara Levy, Chairwoman of the Relative Value Scale Update Committee (RUC), commented on the American Medical Association’s (AMA’s) decision to have minimal primary care participation on the RUC, saying the committee is an “expert panel” and not meant to be representative.

Since the committee is made up of 27 specialists, one …

Cancer is a crime, and how a tumor board is the courtroom

Kevin

Patient

May 2, 2011

by Katherine O’Brien

Cancer patients usually say they want a cure. Well, of course, that goes without saying. But it’s also kind of annoying.

We’ve all, as children and adults, had those “What if” conversations. What if you could have anything you wanted in the whole world? Depending on the respondents’ ages, people might say anything from “a …

A neurosurgeon considers stepping out of her comfort zone

gcs15, MD

Physician

April 30, 2011

There are few things I enjoy more than talking about the spine and the brain.

Therefore, it stands to reason that I enjoyed our state neurosurgical society meeting recently. I don’t like big national meetings, being an introvert at heart. Our state meeting, however, is small; this makes for a more intimate atmosphere and more outspoken dialogue. Colleagues from across the state can exchange ideas, new techniques, and opinions. We also …

How a patient’s organs could live on and be life saving to a recipient

Jim deMaine, MD

Patient

April 28, 2011

Sam was late and Ella was furious. “Now why isn’t that man back by now? He knows it’s time to leave for church.”

The hours began to pass and Ella became frightened. Sam had gone out for his usual two mile run and had simply disappeared. Ella called friends and neighbors but no one had seen him. Panic began to set in so Ella called 911 who connected her to the …

9 websites that savvy medical practices use

Rosemarie Nelson

Physician

April 28, 2011

It’s easy to get caught in the surf on the Web. But plug these URLs into your browser and explore some simple tools that can help not only keep your practice above water but help it ride high.

www.digitalassent.com

Digital Assent automates the patient intake process with a PatientPad instead of the clipboard and an online tool for advance registration. It does integrate with EMR systems, but it provides another strong operational …

Arm amputation from a rare sarcoma

Felicity Billings, MD

Patient

April 25, 2011

Harold was 51 years old and needed his left arm amputated. A year ago he noticed some swelling in his forearm and went to his primary care doctor.

An MRI showed something. It was small and hard to define, hard to categorize, probably a collection of blood, but there was an outside chance it could be a sarcoma, a tumor originating from muscle …

Read more…

Arm amputation from a rare sarcoma

How to discharge a patient from your practice

Adam Alpers, DO

Patient

April 25, 2011

Occasionally, you may encounter patients who you no longer wish to treat. Reasons for ending the physician-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills.

While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk …

Can the Relative Value Scale Update Committee (RUC) be defended?

Brian Klepper, PhD

Health Policy

April 19, 2011

Recently, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC).

For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation …

MKSAP: 63-year-old woman with a 4 week history of fatigue

mksap

Conditions and Diseases

April 16, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 63-year-old woman is evaluated during a follow-up visit for a 4-week history of fatigue; pain in the proximal interphalangeal joints, knees, and hips; and low-grade fever.

She has not had joint swelling, chest pain, or shortness of breath. Over the past 4 years, she has …

Judicious use of complex medical procedures

Kevin

Physician

April 15, 2011

by Shanti Bansal, MD

In the cardiac catheterization lab one Tuesday morning, I encountered a situation that made me reflect on a bit of 18th-century British history.

At that time, the British government was overburdened with prisoners. A plan was hatched for sea captains to transport many of them to Australia. Due to poor conditions, up to one third died on the voyage. Politicians and clergy members …

AMA: Getting the best value for our health care dollars

Cecil B. Wilson, MD

Physician

April 14, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com.

As physicians, many of us realize on some level that our practices contribute to our state and national economies – we just lacked the empirical evidence to understand how much.

That changed last month, when the American Medical Association released a report that studied the economic impact of office-based physicians. While a handful of states have previously studied the economic impact …

Policies prohibiting collaboration between physicians and industry

Thomas Sullivan

Physician

April 13, 2011

As the number of restrictions on physicians working with industry continue to grow, and the places where policies prohibit physicians from collaborating with industry expand, close examination of the reasons supporting these policies is necessary.

The current trend of academic medical centers (AMCs), professional organizations, and States that have begun adopting policies that restrict permissible interactions and activities between industry and …

Federal workers worried about a shutdown should do what doctors do

Edwin Leap, MD

Physician

April 10, 2011

I have a suggestion for all of those federal workers who were concerned about a government shutdown.

To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’

It is ironic, but hardly surprising, that the …

Why patients seek a second opinion

Howard Luks, MD

Patient

April 10, 2011

This has been a very busy week already. I have seen many second opinions and I am always very interested in the reason why the patient initiated the second opinion.

In many situations it was simply to see if I would perform the surgery. After I spent a while listening to the patient, examining them and coming up with an appropriate …

Read more…

Why patients seek a second opinion

Are memory loss and mood disorders actually diabetes of the brain?

Kevin

Conditions and Diseases

April 9, 2011

An excerpt from Feed Your Brain Lose Your Belly.

by Larry McCleary, MD

As diseases, memory loss and mood disorders appear to have very little in common. But could memory loss (even severe memory loss such as that which occurs in Alzheimer’s disease) and mood illnesses such as depression and bipolar disorder, actually be treated much the same …

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