This past spring, I wasn't sure if I was looking through a fun house mirror when I read that Florida pediatricians were going to face criminal charges for bringing up the topic of gun safety in the office with patients. I couldn't believe what I was reading.The irony of the whole charade was the reasoning of those who brought about the bill. "Direct questions about firearm ownership when it ...
September 2011
All Stories
Efficient billing in your medical practice
Billing is way more than billing.In a typical medical practice, more than 300 insurance cards cross the front desk every month. The variety of plans and coverage along with the complexities of coding and the difference among payers requires expertise and technology to effectively manage accounts receivable, regardless of practice size.There are two basics required to manage your billing and accounts receivable -- a practice management system and a clearinghouse.The ...
The pivotal role of social media in patient support
I would have told you, on our first visit, that I don't do well with soft science. But you appeared rushed, with an office full of patients, and I did not feel that I needed to explain my personality. You see, I am a logical and rational thinker, and my primary goal in life is to understand the world around me. I need proof. And then I probably need even ...
Kids and their fascination with foreign objects
Kids will swallow or poke up their noses, or into their ears the strangest things. I remember during my student days, I was doing a rotation in pediatrics when a 6 year old came into see us. I went in to take the history and her mom told me that her daughter had a very pungent odor to her, which she couldn’t get rid of.I examined the patient and ...
Discussing a colostomy in a patient with rectal cancer
Sturdy and thickly-built, long since widowed, cheery in a sardonic sort of way, tough and opinionated, Flora's European roots ran deep; she'd been an Italian farm girl, and she'd rather be in her garden than anywhere else. The only reason she agreed to come inside and go to the doctor was that her bowel movements had finally gotten too painful, and too bloody to ignore. Which she had been doing, ...
Why an ACO is essentially an American product
There has been a significant outcry against the proposed ACO regulations: everything's wrong and nothing's right about them, or so some would have us believe.Today's "nattering nabobs of negativism" focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure incuded), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, ...
Elimination of industry support for CME
Something huge happened at the American Medical Association House of Delegates meeting. Although the meaning of what happened will be spun throughout the blogosphere, twittersphere, and schmuckosphere, the bottom line is that the AMA just voted most commercial funding of CME out of existence.Specifically, the delegates voted to approve a report of the AMA ethics committee that calls for a near elimination of industry support for CME. The report is ...
Appropriately dejected after an annual physical
Print out the eye chart, cover one eye, and see how you read it from 20 feet out. I failed line 8 abysmally.I went for my annual check-up, and I must say, this doctor was thorough. In fact, he was too thorough. He told me way more than I ever wanted to know.During the two-hour examination, I found out I’ve gained weight (too much ice cream), my blood pressure ...
Exercise can help treat fibromyalgia
What is fibromyalgia and what exactly what does exercise have to do with the treatment and long-term outcome of the condition? A recent study published in Medicine & Science in Sports & Exercise is helpful in understanding the relationship between fibromyalgia and exercise and how clinicians (and patients) might find better strategies for treatment.Fibromyalgia is a clinically defined pain syndrome estimated to affect about 5 per cent of the general population with criteria for ...
Are medical students responsible for the primary care shortage?
There is a lot of speculation about why there are fewer and fewer primary care physicians joining the workforce every year. Some have focused on the choices that medical students are making when choosing residencies. Whether due to laziness, desire to make money or the drive to be perceived as “successful” in choosing a more prestigious specialty, the new generation of physicians are being blamed for not ...
The value of a mentor during medical training
I grew up playing a variety of different organized sports. Looking back now, I notice that no matter what the sport my best performances were always on teams which were led by inspiring coaches. The same could be said about my education, with teachers replacing the coaches. Whether I knew it at the time or not, throughout my life I have had a number of mentors who have brought the ...
Quitting your job and living the dream
Ever dream of quitting your job, moving somewhere deliciously tropical and spending the rest of your days doing what you love (and even making a good, or great, income from it)?This story isn't about me, though some of you may know that I spent 2004-2008 living my dream life in Mexico (Puerta Vallarta and Los Cabos), making much of my income from my writing, dancing, coaching and speaking and occasional ...
Doctors need celebrities to spread the vaccine message
Presidential candidate Michele Bachmann has been in the health care headlines recently, saying the HPV vaccine was dangerous.Although doctors and other health experts, along with editorials in major newspapers, rebutted her claims immediately, they didn't stand a chance.The damage was already done.A piece from the New York Times explores the power both celebrities and politicians have when it ...
The progress we have made in the diagnosis and treatment of cancer
An article released by the Centers for Disease Control and Prevention in their weekly publication Morbidity and Mortality Weekly Report provides an assessment of the progress we have made in the diagnosis and treatment of cancer.Clearly, since 1971, we have made substantial advances in the cancer treatment. We have become a larger and older nation. ...
A place for business in medical school
A recent article in the New York Times business section discusses an increase in the number of doctors getting M.B.A.'s in addition to their M.D. degree. In fact, there have even been many new programs that combine getting both of these degrees together. The article emphasizes the importance of seeing that "healing is an art, medicine is a profession and health care is a business." However, is adding more ...
Why doctors should be careful with Groupon and other social coupons
I just received a Groupon for dental services. I have seen Groupon’s in the past for medical services and I can’t figure out how selling medical services via a social coupon (the generic name for Groupon like sites) is legal. This is dangerous, uncharted territory. Consult your attorney before running a Groupon.As I run practices in New York, I will focus on the their statutes. New York has some of ...
How to ask for help when chronic pain or illness strikes
How many times have you said to a friend or relative in need, "Let me know if there’s anything I can do to help," and when you didn’t hear back, fail to follow-up? I’ve lost count of the number of times I did just that—fail to follow-up when I didn’t hear back from someone in need, even though I would have been happy to help in any way I could.Yet, ...
Confirmation bias in both physicians and patients
We are all guilty of confirmation bias from time to time.Confirmation is something that resident physicians in particular are guilty of more so than experienced, qualified physicians. Resident physcians and attending physicians alike may quickly form a diagnosis in their mind during a brief discussion with a patient. Now they will try to convince themselves (sub-consciously) that the other complaints and physical exam fit that diagnosis. They force ...
ADHD and the lack of quality sleep
As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults ...
What do you think caused your disease?
Our first assignment for medical school involved reading and discussing Anne Fadiman's The Spirit Catches You and You Fall Down, which describes how a clash of two cultures (medical and recently immigrated Hmong), miscommunication, and misunderstanding led to tragedy. Poignantly narrated, the book had the take-home message: if a patient does not agree with a physician's reasoning why a disease developed and how it can be cured, then even the best ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
