No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income.   An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices.  One of the best ...

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My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry. So we gave medication to start labor, and the nurses placed ...

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All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble ...

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Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit: "You know, I just wanted to say that I really ...

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On a recent international flight to London, a passenger required medical assistance.  I don’t know if it is the karma of London but this is the second medical emergency on a plane headed to London that I have encountered. I was only a couple rows behind the passenger and could see even before the crew announced the need for a doctor that he needed assistance.  I jumped over the woman ...

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It was 1976 and I had just started my solo practice.  I employed only a receptionist and a nurse.  My nurse was absent because of an illness and I asked my middle-aged mother to come and serve as my chaperone for the afternoon. The first patient was a young lady and I asked her to give a urine specimen and place it in the turnstile in the restroom.  My mother, wearing ...

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Since it strikes at the very core of what this blog is all about, I couldn’t pass up the opportunity to comment on Dr. Karen Sibert's recent op-ed piece in the New York Times. She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting interests, such ...

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"I need you to do me a favor," my nurse asked me at the end of our day on Friday. "Sure," I answered, "what do you want?" "Please have a better week next week," she said with a pained expression. "I don’t think I can handle another one like this week." It was a bad week.  There was cancer, there was anxiety, there were family fights, there were very sick children.  It’s not that ...

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The word "holistic" has been kidnapped by practitioners of alternative medicine and marketers.  Holistic has become synonymous with "all natural" treatments and cures.  Those who kidnapped the word holistic imply that medical doctors are not holistic.  The implication is that docs treat the disease and not the person. According to the Merriam-Webster Dictionary, holistic means, "relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment ...

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Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine.  It is called de-skilling.  De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things.  Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P), patient centered medical home (PCMH) requirements and so on. Examples of ...

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