DSC7649-1024x770 Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice. A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking ...

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I had a pretty grueling office session yesterday -- one of those days where you're sending someone to the hospital and calling another consultant on the phone and bouncing among three rooms at once.  A typical family medicine day. I was 45 minutes late seeing my last patient.  I was a little surprised that she was still on the schedule -- we had actually resolved her issue over the phone the ...

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Next in a series. There is and will be a need for many more primary care physicians (PCPs). Why? There is a shortage now and it will be exacerbated in the coming years for at least three reasons. The population is growing, the population is aging and there will be more individuals with health care coverage as a result of the Affordable Care Act (“Obamacare”). I believe that the need will be much ...

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Merrill Markoe's reports that she was fired by her doctor in her article, "My Doctor, the Concierge," which was both sarcastically entertaining and painfully true.  She writes a powerful commentary on the divide caused by insurance companies between doctors and patients.  She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy ...

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"Just start work half an hour earlier." This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles. She suggested that if we started our usual practice morning at 8 o'clock we should just have everybody come in at 7:30 to load the dashboards for the morning session ...

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As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home. We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about ...

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I have just turned on my computer. It is midnight. I should be trying to sleep right now. My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, ...

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Several years ago I took care of an elderly woman in the ER.  She came in with a chief complaint of chest pain.  She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better.  She didn’t know she was about to die, usually people who are about to die look much worse. She looked good, all things considered.  ...

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shutterstock_112344575 Walking parents through the decision to vaccinate their children is a conversation. The vast majority of the time it is an easy conversation. Sometimes it is difficult. If the conversation goes like this, then we, as doctors aren’t doing our jobs: Pediatrician: “Are you going to vaccinate your child?” Parent: “No.” Pediatrician: “Get out of my office.” The medical community has lost a lot of ground ...

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The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be. While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state ...

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