Why doctors need to be better negotiatorsPediatrician Rahul Parikh has a great piece in Salon, Why doctors can’t say no. You should go read it. In the piece, he cites a recent study showing that, in about 10 to 25% of cases, patients come into an office visit with an agenda, or something specific they request. It can be an antibiotic, x-ray or a scan, for ...

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How patient satisfaction scores reward rich hospitalsMedicare is beginning to tie financial bonuses to hospital patient satisfaction scores. Although patient satisfaction is important, I've voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys. In a previous USA Today column, I wrote, "already, more than 80% of doctors ... said patient pressure influenced their medical decisions. And in primary care, ...

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The malpractice risk of high deductiblesAs the cost of health insurance rises, patient deductibles are getting bigger. More doctors are reporting that patients are coming in less frequently for chronic care followups, skipping medication refills, or balking at the out of pocket costs for various tests. Sometimes, however, this can get physicians into trouble. I was reading through a copy of Massachusetts Medical Law Report, and saw ...

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Doctors and patients cannot win when it comes to chronic painThe following op-ed was published on September 18, 2011 in USA Today. A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, "You doctors need to wake up and realize that patients (who are) in pain are in a no-win situation." The patient was absolutely right. This summer, the Institute of Medicine ...

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The medias role in educating patients about MRI overuseThankfully, there have been more news stories recently illustrating the overuse of tests. Specifically with cancer screening, the PSA test and mammograms have come under increasing scrutiny. I think this type of media attention is long overdue, as the public needs to be aware of the potential downsides of diagnostic tests. Now comes the MRI. A recent piece in the
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The power of gut feeling in cancer screeningCancer screening has always been an emotional topic. In recent years, both prostate and breast cancer screening have come under increasing scrutiny. Studies are beginning to question the benefits of early detection, and, in the case of prostate cancer screening, whether more harm is done than good. In fact, the USPSTF recently downgraded their prostate cancer screening recommendation. In a recent study ...

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How new doctors will kill private practiceWhat are new medical graduates looking for in their first job? According to American Medical News, they're looking for jobs with the following criteria: "The most important items would be the ability to show a stable, growing practice and quality of life ... The stability would come from a practice that generates most of their collections from commercial insurance, ...

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Prostate cancer screening requires patient inputPredictably, reactions to the USPSTF's prostate cancer screening guidelines are all over the map. Consider editorials from two national newspapers, the New York Times and USA Today. USA Today wants readers to ignore the recommendations: "Here's our suggestion for the 50-plus male: Get tested, then get smart. Information about prostate cancer and its treatment is readily available from the ...

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USPSTF prostate cancer screening guidelines need emotion to resonateProstate cancer screening has always been controversial. Now, with the USPSTF is recommending against screening for prostate cancer, gas is about to be poured on the proverbial fire. Recently, the New York Times Magazine published a lengthy piece on the issue, perhaps not coincidentally, perfectly timed with the Task Force's announcement. In 2009, advocates for breast cancer screening were ...

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Cancer screening is plagued by dissonanceLast year, the USPSTF was poised to meet regarding its prostate cancer screening guidelines. According the Kenny Lin, a physician who was with the Task Force at the time, the meeting was cancelled for political reasons. He points us to a New York Times story on the dueling narratives of prostate cancer screening. It's a topic that often appears ...

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