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 …
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 …
Prostate enlargement, or benign prostate hyperplasia (BPH), is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.
The symptoms of prostate gland enlargement include a decrease in the force and caliber of the urinary stream, frequency of urination, urgency, a feeling of not emptying the bladder despite urination and nocturia, or the need to get up at night to urinate. Although lifestyle changes will not cure …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for a new right-sided headache that began 1 day ago. He awoke yesterday with a dull ache over his right forehead that has gradually increased in intensity. He also notes some right eye discomfort, sensitivity to light, and that his eye …
“I have bipolar disorder. Can I be a doctor?”
It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …
Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.
As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …
It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.
That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …
A reader recently asked, how does someone find a good psychiatrist?
Stated another way, the questions are:
I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …
Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem. A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.
What do I mean? Here are some examples from my field.
Treating …
Abdominal pain is the bane of many emergency physicians.
Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.
In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …
I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.
Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …
Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.
A 49 year old healthy woman presented to …
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.
Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …
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Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.
What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.
Cocaine is one of the most potent anesthetic and vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and …
How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.
Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …
During my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: “When you hear hoofbeats, think of horses not zebras!” He would also frequently use: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” What did my mentor, the Sage of HCMC, mean by this?
From Wikipedia: “Zebra …
Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?
Your problem may not be a problem with your attention. In fact, it may be that the …
Seems like a simple enough question: How do you find a psychiatrist?
It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.
We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your Insurance, …
by an anonymous physician
I am a physician now in recovery.
I don’t like that term. The correct thing to say is, I am sober. I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple. It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either. I know this …
The first time I let a medical student try to intubate was in August. Now in my final year of anesthesia residency, I had volunteered to mentor a third-year medical student for a week. A few weeks in advance I got an email with the form she had filled out. Anesthesia experience: none. Excited to learn: yes.
I met her on Monday morning after she navigated through the preoperative holding area …
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