Physicians are struggling to adapt to a sea change in the health care delivery system. Solo physician practices are disappearing, small group practices are merging to become larger, and large group practices are being acquired by hospitals and integrated delivery systems. All of this is occurring in a milieu of decreased fee-for-service reimbursement from government and private insurers, bundled payments and pay for performance, increased levels of student loan debt, ...

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Following the recession, the Obama administration sought shovel-ready projects. One unlikely shovel-wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 percent of the stimulus towards digitizing medical records. Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between ...

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A continuing series on physician online reputation.   For more KevinMD minutes, please visit my YouTube channel. What do you need to do before starting your online presence with social media? They are your bio and your head shot. Together, they will be your first impression to patients who find you on the web. First, let's talk about your head shot. Make sure it's a high resolution image. ...

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During my family medicine rotation, my very first clinical clerkship of medical school, I received the assignment of making a home visit to one of my preceptor’s patients -- a man I will call Mr. Jones. Mr. Jones had congestive heart failure, COPD, and a barrage of other chronic health problems. He was a pleasant gentleman, but had a low level of health literacy and had been doing a poor job ...

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I have spent 32 years working in hospitals and the last 16 running them.  Hospitals are created for the benefit of the community, a place where people go when they are acutely Ill, injured or have a complex condition that eludes quick diagnosis and treatment.  Hospitals historically provided primarily inpatient care and comprehensive diagnostic and treatment facilities for patients. It took a major snowstorm -- one of many we endured this ...

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After four years working as a child and adolescent psychiatrist in Brooklyn treating the underserved, I decided it was time to dedicate myself fully to my growing private practice. Functioning solely as an out of network provider in private practice, as expected, my clientele grossly changed. Unlike my hospital patients, a majority of my patients are upper class to wealthy. Finances are not concerns or stressors. Wealth does not predict a decrease ...

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medpagetodayFrom MedPage Today:

  1. Sleep Apnea Linked to Depression in Men. Obstructive sleep apnea (OSA) is associated with an increased risk of depression in men.
  2. Tapering Asthma Meds Saves Money in Stable Patients. Reducing asthma medications in stable patients led to cost savings without increasing utilization of other asthma resources.
  3. Poor ...

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One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured. Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program ...

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A couple of years ago, my clinical practice (Dermatology Associates at Massachusetts General Hospital) began sending patients a bill when they did not show up for an appointment. Dentists do this with some frequency, but it’s unusual for a physician practice to do it. Our reasoning was that we have many folks who insist they need to be seen right away and, despite a large, busy practice (we see more ...

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Enough already about Dr. Oz. Whichever side you happen to be on, we might collectively acknowledge that much of the noise being made about what is, at worst, a symptom, is itself an indication of a culture-wide disease. The fate of Ozymandias comes to mind. Science is Ozymandias. Soundbites are the ruin of it. In the case of the Oz saga, it's abundantly clear to anyone who actually
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The buzzwords many use in medicine today are "personalized," "individualized," or "targeted." Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions to unique patient characteristics, such as genomic data. (The White House's Precision Medicine Initiative is an example of this kind of thinking.) Although I am skeptical that big data-driven genetic ...

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As I have been known to say on this blog once or twice before, one of my favorite things about being a developmental pediatrician is the opportunity to follow the children I see for initial diagnostic evaluation over the long term. New research presented at the Pediatric Academic Societies conference makes me especially hopeful. When our clinical ...

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There he stood at our beach party, the family doctor I grew up admiring. I timidly approached his circle of friends to announce I had gotten into medical school and would start in the fall. He stopped to attention. His friends stood watching. I couldn’t conceal my smile. I thought, “He is going to be so excited for me!” “Get out now.” Before I could respond, he continued. “The profession isn’t ...

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medpagetodayFrom MedPage Today:

  1. Overactive Bladder May Set Seniors Up for a Fall. A diagnosis of overactive bladder (OAB) significantly increased the risk of falls among a Medicare population.
  2. IBS: Peppermint Oil May Be a Treatment Option. A slow-release peppermint oil (IBgard) appeared to significantly reduce severe abdominal symptoms of irritable bowel syndrome ...

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shutterstock_118623196 I’ve been a doctor for more than 20 years, and I hate to break it to you, but it’s time I came clean: We lie. Doctors lie. Not always. Not necessarily on purpose. But we do. Sometimes the lies are to our patients. Sometimes, the lies are to our families. And sometimes the lies are to ourselves. But, nonetheless, we lie. A lot. ...

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Jordan Grumet reads from this new book, I Am Your Doctor: and This Is My Humble Opinion. I highly recommend this poignant look at what's it like to be a physician today.

Some doctors love to do procedures.  Stitching, skin biopsies, removal of ingrown toenails -- you name it, they’ll do it, and then they’ll ask for more.  In fact, I used to have a senior partner who actually told me he preferred doing procedures more than any other type of visit.  When I asked him why he enjoyed procedures so intensely, he shrugged and said, “Because I don’t have to think ...

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I was recently talking to a patient about having some extra help at home when she left the hospital with home nursing services. The elderly lady -- highly intelligent and fiercely independent -- politely declined with the reply: “No, I’m fine thanks Dr Dhand -- all they’ve done before is just come in with their computers, barely talk to me, enter a few things on their keyboards and then leave.” This ...

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That first time there was a moist sweet smell, the hiss of oxygen and pictures of grandchildren on the wall. Unopened juice containers, papers, a Kindle, the phone and some plastic table wear, crowded the bedside stand. Jack was thin, tired, and the tightness of his eyes spoke of uncontrolled pain. “Oh, I know you. You took care of my wife’s friend. You’re the cancer doc.’ “Yes, that’s me, nice to meet ...

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On May 2, 2015, at approximately 6 a.m. local time, the Duchess of Cambridge was admitted to the Lindo Wing of Saint Mary’s Hospital after going into labor. At 8:34 a.m., the Duke and Duchess welcomed a baby girl, Charlotte Elizabeth Diana, into the world weighing 8 lbs. 3 oz. Kensington Palace announced the arrival of the fourth royal in line to the British throne at 11 a.m. At around ...

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