Consider the following two clinical scenarios:

1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago.  His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s “too late” for his business to recover.  His adult son and daughter admire him greatly, but his ex-wife denigrates him and does everything she can to keep their children from seeing ...

Read more...

By now you’ve probably heard of the concept of “concierge medicine.” To me, it’s an idea that’s Win-Win-Lose: Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of  charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge ...

Read more...

Dont overwhelm patients with unnecessary detail It is not an easy time to be a physician in the United States.  Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision.  Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services.  To make matters worse, ...

Read more...

I recently saw a 90-year old patient in my cardiology office practice. She was demented, but cooperative with the exam. A devoted daughter, with whom she lives, accompanied her to the appointment. Her dementia was severe enough to make a cogent history from the patient impossible. However, the daughter had something on her mind, and it had nothing to do with her mother’s heart condition. “My mother’s primary care doctor wants ...

Read more...

Why doctors should have clean and organized desks What is your impression of an airlines when you sit down and open the tray on the back of the seat in front of you and find food and coffee stains on the tray?  You may just worry if the same attention that was given to tray tables carries over to the maintenance of the engines.  Or what is your opinion ...

Read more...

Doctors: How to improve your workplace relationship with nurses Accepting a promotion in the workplace is never easy task.  One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office. Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner ...

Read more...

A story about dying that ended up being a story about living I want to tell you a story about dying that ended up being a story about living. A few years ago, I was an eager-beaver third-year medical student, and relished the opportunity to finally work on the wards. One of my patients was Mr. Taylor, a middle-aged man with pancreatic cancer—a disease that, of course, carries a bleak prognosis. He was emaciated, ...

Read more...

4 reasons why doctors should be outraged Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication we requested. Outrage #2: Choosing a medication for cost, not effectiveness. A child cannot breathe because the acid and other nasty stomach ...

Read more...

An excerpt from Pet Goats and Pap Smears. I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me. Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural ...

Read more...

Waking before dawn, I scurry into the study.  Sitting in front of the computer, I wiggle the mouse, bringing the screen to life.  Hesitantly, I call up the site for the major local newspaper.  Since being notified by my attorneys one week prior that a reporter was hunting me down for comment, I am on heightened alert.  Every day spent awaiting a story that could potentially decimate my life. The home ...

Read more...