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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With computerized health systems, physicians can place orders as easily as they can shop online at Amazon.com. Just a few clicks and your physician can purchase a panel of blood tests, futuristic imaging and diagnostic procedures that will hopefully guide their path to solving your ailments. Search. Click. Submit. Repeat. Except, unlike online shopping, physicians don’t see the price tags and they never get the bill. Doctors are the true consumers ...

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Billing is way more than billing. In a typical medical practice, more than 300 insurance cards cross the front desk every month. The variety of plans and coverage along with the complexities of coding and the difference among payers requires expertise and technology to effectively manage accounts receivable, regardless of practice size. There are two basics required to manage your billing and accounts receivable -- a practice management system and a clearinghouse. The ...

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Something huge happened at the American Medical Association House of Delegates meeting. Although the meaning of what happened will be spun throughout the blogosphere, twittersphere, and schmuckosphere, the bottom line is that the AMA just voted most commercial funding of CME out of existence. Specifically, the delegates voted to approve a report of the AMA ethics committee that calls for a near elimination of industry support for CME. The report is ...

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There is a lot of speculation about why there are fewer and fewer primary care physicians joining the workforce every year. Some have focused on the choices that medical students are making when choosing residencies. Whether due to laziness, desire to make money or the drive to be perceived as “successful” in choosing a more prestigious specialty, the new generation of physicians are being blamed for not ...

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I just received a Groupon for dental services.  I have seen Groupon’s in the past for medical services and I can’t figure out how selling medical services via a social coupon (the generic name for Groupon like sites) is legal.   This is dangerous, uncharted territory. Consult your attorney before running a Groupon. As I run practices in New York, I will focus on the their statutes.  New York has some of ...

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We are all guilty of confirmation bias from time to time. Confirmation is something that resident physicians in particular are guilty of more so than experienced, qualified physicians.   Resident physcians and attending physicians alike may quickly form a diagnosis in their mind during a brief discussion with a patient.  Now they will try to convince themselves (sub-consciously) that the other complaints and physical exam fit that diagnosis.   They force ...

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More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a "professional courtesy." According to the Office of Inspector General's (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation. To be sure, not all professional courtesy discounts or free ...

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Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice: 1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use. 2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and "overdiagnosis" of nonexistent diseases. 3. Lack ...

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I wear lots of hats.  Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do.  Analogies help people conceptualize the complexities of medicine in a way that makes sense. Today, I had my chef’s hat on.  I was actually treating a young chef and found myself talking about food and medicine.  There is a direct correlation.  My ...

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