A few years ago, I sat in a coding lecture for urgent care providers given by a very entrepreneurial physician assistant. An emergency room doctor, who had recently established his own private clinic, put up his hand to ask a question. He seemed puzzled. “I can see your point about coding at a higher level for a sore throat when I was younger,” he said. “I used to take longer to ...

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Bobby was admitted to the hospital once again with overwhelming fatigue and shortness of breath. Yet this 37 year old farmer looked the picture of health. He grew up on a farm rising before dawn, milking cows and working long days in the fields with hay or corn. He was never seriously ill as a child and was a good football halfback in high school. But this was his third admission ...

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I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don't go so well, lest you be led to believe that I have magical powers over my patients and their families. Here are two of my attempted end of life map conversations that did not go over so well. In fact, ...

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I was listening to CBS This Morning recently as they were interviewing Alan Alda. He was discussing his acting career and being the host of Scientific American’s Frontiers (airs on PBS stations). Alan Alda relayed a personal story of his, having an intestinal blockage while he was filming an episode in Chile. As he relayed this incident, he spoke of the physician who told him that he was going to remove the ...

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Like my fellow Connecticut residents still shaken by the Newtown shootings, I was excited and relieved when Connecticut Senate Bill 1160 (“An Act Concerning Gun Violence Prevention and Children’s Safety”) passed. The law establishes a dangerous weapons offenders registry and requires a universal background check for all gun purchases. Those wishing to purchase long guns will need an eligibility certificate which requires fingerprints, a firearms safety training course and a ...

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Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefiting business, and is now mainstream without challenge from our profession nor the public. Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a ...

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As of early April, you can walk into Walgreens in 18 states (plus D.C.), and along with a gallon of skim milk, a pair of photo mugs, a six-pack of toilet paper, and a flu shot, you can meet your new primary care provider, get your cholesterol checked, pick up your statin, and schedule a return visit. That primary care provider will not be a physician ...

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“You have to be affable, available, and able,” a senior general internal medicine physician taught me during my final year of residency. “Trust me,” he added, “when you’re in practice, you will love easy consults.” A consult – short for “inpatient consultation” – occurs when physician caring for a hospitalized patient requests another physician to evaluate the patient and provide recommendations.  Typically, both physicians are paid – one for providing overall ...

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A young lady comes to the emergency department and wants to be evaluated for a somewhat non-urgent problem. Chief complaint: “I’ve lost 50 lbs in the past month.” She felt a little weak as well, but she had just lost too much weight. No other symptoms. The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed ...

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shutterstock_107615549 Radiologists care about their patients, even though most diagnostic radiologists don't meet and greet their patients the same way direct-care clinicians do. Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work in ...

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