trash-can There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against. I received the following mailing:

We want you to screen our members for cancer.  Please do these things:
  • Call the member to discuss colorectal, skin, and prostate ...

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shutterstock_74641645 When I was a med student, the thing I loved most about primary care was continuity of care. I loved feeling like I had a sense of my patients’ lives, of the intimate details of their day to day, of their fears and dreams. I thought that this connectedness was all I needed to have a successful career as a primary care ...

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Guantanamo detainees on a hunger strike are now being strapped into chairs and gagged as doctors push a feeding tube through their nose into the back of their throat and into their stomach as often as twice a day. It’s a disturbing new practice, but one we must examine in full as we consider whether Guantanamo reflects American values. Anyone who has had a nasogastric tube placed through their throat while ...

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Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy. -Mark Twain Returning to clinic after time off for a summer break, I worry I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake.  Just maybe no one will notice I don’t ...

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The Mayo Clinic Proceedings came out with a study that shows that many of the treatments that doctors once swore by are useless or worse. The New York Times did a piece on it and the commentary contained a great deal of doctor-bashing.  So of course I opened my big mouth and pointed this doctor hatred out.  The comment I got back was this:  "It’s not hatred, it’s fear." Wow.  If people ...

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I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good. I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came ...

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I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling ...

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This is an interesting dilemma, but honestly, I could use your help. A former neighbor (not a close friend, but a pleasant fellow whom I run into less than occasionally) rented a house to a medical student and his family. They seemed reliable enough, and signed a 4 year lease. Over time, the medical student and the landlord began to feud over who does what. Usually things like landscaping were at ...

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Two recent articles highlight the challenges we will face as our healthcare system changes with regard to how care is delivered and reimbursed. The first article from the New York TimesMedicare Panel Urges Cuts to Hospital Payments for Services Doctors Offer for Less, notes that large hospital-centric systems of care do not necessarily serve patients well in terms of cost and sustainability. The second on the front page of ...

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shutterstock_125691797 What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of "it doesn’t really matter, as long as they are competent and do a good job.“ Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in ...

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