I may not accept your insurance, but I will always accept you Just for the record: I am happy to see you -- irrespective of your insurance. I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason. I will not sign a contract with a health insurer that: Abuses and bullies me and/or my patients. Denies all my first claims. Reimburses me so little that I may go out of ...

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Top stories in health and medicine, July 29, 2014From MedPage Today:

  1. Smoking Worsens Psoriatic Arthritis. Patients with psoriatic arthritis who smoke have worse patient-reported disease features at baseline and don't respond as well as nonsmokers to anti-tumor necrosis factor (TNF) treatment.
  2. Heart Defects Still Often Found Late. Prenatal diagnosis of critical heart defects has increased, but more than one in ...

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She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year ...

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It's a seductive idea.  We doctors possess knowledge and experience which can not only help people, but can save their lives.  We get opportunities to be the right person at the right time to offer the right help that makes all of the difference.  It's one of the greatest things about our profession.  It's also one of its greatest traps. I've heard many doctors refer to themselves as "healers," as if ...

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Doctors today: Young, broke and human “Oh, you’re my doctor? A woman?” Who do you picture walking through the exam room door at your new doctor’s office? Is it the Norman Rockwell depiction of an older, jolly looking male? After residency I was alarmed at how many patients commented on my age and gender: “How old are you, 12?” or, “Oh, you’re my doctor? A woman?” This got me thinking about ...

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The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law. The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do ...

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Recently, the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled "Skill Reviews Upset Doctors." While it is certainly nice to see an article reaching the main stream media concerning doctors' concerns with the MOC program, the issue with the MOC debate is not that doctors are upset.  The real issue is ...

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Let me begin with by extending a hearty congratulation on matriculating to medical school. The pre-med years were tough with organic chemistry, staying involved with leadership activities, chasing down the elusive letter of recommendation, and sitting for the MCAT. But you did it. Be proud of what you've accomplished because you're one step closer to becoming a doctor. You may have fears, concerns or misgivings about what is coming your way and this ...

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Part of a series. Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples. AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to ...

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An interview with Jessie Gruman Jessie Gruman, who sadly died July 14, 2014, was someone I greatly admired as a person and as a patient activist. I interviewed her in late April for research I was conducting on patient activism, and she graciously allowed me to publish the interview, wanting, not surprisingly for those who knew her, to do everything she could to use ...

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Top stories in health and medicine, July 28, 2014From MedPage Today:

  1. Time to End Lethal Injection? The third botched execution of a death row inmate in a year should serve as proof enough that lethal injection won't work as an execution modality.
  2. HIV Cure Still Years Away. The African journalist asked a simple, clear, and direct question: When, people want ...

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One of the skilled nursing facilities I work with has a hospice unit.  We occasionally have patients on the hospice unit who might benefit from physical therapy.  The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient.  If the goals are ...

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As a family physician whose practice deals exclusively in the treatment of obesity, it strikes me as remarkable how little we understand about the disease, which is Canada’s second-leading cause of preventable death. In every region of the developed world, obesity doubled in the twenty years between 1988 and 2008, according to World Health Organization, which now count more than a half-billion of Earth’s population as obese. The Public Health Agency ...

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The house was getting cold.  My wife and kids snuggled in their blankets as I crept out of bed and checked the thermostat.  The subzero winter air howled as a blustery morning took shape outside our windows.   I looked at the digital display with disbelief and manually tapped the screen with my finger, hoping that the jarring motion would loosen the exact faulty screw leading to our frigid state. ...

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In medicine, the patient is not always right Beginning with the Institute of Medicine's (IOM) landmark Quality Chasm report in the late 1990s, the health policy establishment, the medical profession and the American public began to hear a new and disconcerting message: American health care was not patient-centered. The IOM prescribed a number of recommendations to redesign health care delivery, one calling for patients as the source of control over their care. "Patients should ...

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Many hospitals rely on bond funding for their expansion and the purchase of new equipment.  Revenue that is created by the hospital is then used to pay back the bondholders.  The risk to bondholders is that they are generally paid after the hospital pays its operational expenses.  Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk. Hospitals have historically been rated ...

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Today, I celebrated mental health care.  And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support. I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness.  The diverse stories of ...

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“Dr. Liu, I don’t think he has diverticulitis.” So said the second-year medical student. She had just completed her first year of anatomy, biochemistry, pathology, and introduction to doctoring at the local medical school. One of the sharpest medical students I’ve proctored. Like many summers, I’ve been fortunate to spend time with the next generation of doctors. These future doctors were brimmed with enthusiasm and energy.  Instead of taking time off to ...

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Should I be a nurse or a doctor? Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine.  Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless. But people ask me all the time, so as a little experiment, I ...

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Suicide Med: A medical school thrillerSuicide Med: A medical school thriller An excerpt from Suicide Med. “I wish I had become a ballet dancer instead.” I use the back of my forearm to swipe at strands of dark hair that have come loose from the tight bun at the back of my head. The attempt fails and the escaped locks fall back ...

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