unnamed Heath care documentation is done for three reasons:

  1. health care delivery (that’s the obvious one)
  2. regulatory compliance (checking all the boxes our government and payers think are important)
  3. malpractice avoidance (no one wants to get sued)
These three categories actually apply to every task we do in health care, but let’s confine this discussion to documentation. Note in the accompanying figure, our three basic health care work ...

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“This is our sickest patient,” my co-intern began as she told me about one of her patients I would care for overnight. It was my first week of intern year, and I was assigned the overnight cross-cover shift for a busy cardiology service. Introducing myself as “Dr. Tredway” still rolled awkwardly off my tongue, but I had grown more comfortable throughout the week in my new role as a physician. ...

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shutterstock_137913404 1. Be nice to others, even if there are a lot of butt sniffers out there. 2. Waiting to be seen is really hard. Try to keep a schedule and routine. 3. Get out for that walk. It will fill you with joy, well-being and makes the rest of the day calmer. Take other dogs on that walk to improve their well-being too. 4. “Good ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena. On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse ...

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“If he is hungry when he wakes up, and you don’t let him eat, we’re taking him to another hospital,” the man shouted. I stood trapped between a protective papa bear and his cub. My instinct was to find an exit, but I braced myself for more. This father gave me one last glare before side-stepping around me and wrenching open the door to his child’s hospital room. I glimpsed ...

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I read a fascinating article from ProPublica about a nurse practitioner (NP), Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, the payments ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I love pre-visit planning. OK, “love” may be too strong a word -- I like pre-visit planning. Pre-visit planning isn’t new. Many of you have done it for years, even before it had a name, for example when pre-ordering labs before a visit. I did not begin ...

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This article was originally written on August 11, 2015. My psychotherapy supervisor taught me a tip during residency: to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session. (Because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning.) I struggled to come up with a topic to ...

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shutterstock_104930039 There was once a little boy who loved to draw.  He would wake up every morning, pull out his box of colored pencils, and let his hands explore the promise of a pristine sheet of blank paper.  For him, the canvas was anything but empty,  images and ideas exploded out of his mind and magically appeared on the pages in front of ...

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A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles evaluated. This is nothing new, but it looks to me like there are increasingly more of these articles which celebrate products and fewer interesting articles about the science of medicine. The other thing ...

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I have a confession to make: I sometimes look forward to my trips to the bathroom at work. Being a busy pediatrician, it can be the only alone time I get to myself; and on occasion you just need a quiet place where babies aren’t crying, and phones aren’t ringing. The other day as I was leaving the bathroom and returning to the bustling clinic, I did something strange. I ...

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I was an overachieving, well-rounded and sagacious undergraduate student. I majored in psychology, minored in biology and was an active member of the Psi Chi honor society. I was drawn to the study of psychology, and fascinated by the complexities of mental illness. I became certified as a research assistant and spent many hours with severely depressed individuals, who had become crippled by their illness. I was intensely intrigued by ...

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photoshoot-770x457 Have you ever had a professional photo shoot? I have had many, but not because I particularly enjoy being photographed. Actually, it is quite the contrary. Photo shoots have always been a traumatic experience for me. You see, for some reason, likely as a creative form of cruel parenting punishment, my family of five siblings had a photo taken every year while growing up. ...

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“Dr. Gunter, I think, uh, there’s a fetal skull in the abdomen,” my resident said with that hesitancy that says I want you to tell me I’m wrong. The first time you diagnose something that is very bad you actually hope you are mistaken and want someone more senior to reassure you that you are overreacting and tell you that this is just an odd presentation of something benign. “I’ll be ...

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asco-logo "Why did this happen to me?" That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to “avoid” cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if ...

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asco-logo One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day. With the exception of the new patients on my schedule, I recognized all of the names on my list. I opened the electronic chart of the first patient to skim the problem list, a handy spot where I ...

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growth-in-administrators_opt I’m taking back medicine. If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed. Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots ...

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Being a doctor is one of the most emotionally and physically demanding professions out there. The health care landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that being a doctor was “the most challenging of jobs,” and ...

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shutterstock_284306441 How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for ...

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Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy. First, a healthy donor must be identified.  The donor ...

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