Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical.In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive ...
Nicholas Fogelson, MD
Explaining an abnormal pap smear is no longer simple
As I look back over my 10 year career in obstetrics and gynecology, I am sometimes struck at how many things have been discovered in this time period.When I started the origin of pre-eclampsia was unknown, and now we know that it likely originates in an overabundance of a molecule called Soluble FMS-Like Tyrosine Kinase, a competitive inhibitor to natural angiogenesis in the placenta. Ten years ago the origins of ...
Going through Netter’s to teach medical students pelvic anatomy
I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy. What a blast! There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so ...
Successfully appeal an insurance company reviewer decision
Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is ...
Why your health insurance medical appeal was rejected
One thing that many residents do not know is that there are more benefits to becoming a board certified physician than just that plaque on the wall. One of these benefits is that ability to pick up a few extra hours of work here and there doing consulting for the multitude of companies that would like the opinion or expertise of a physician.In some cases this consulting can be about ...
Autonomy versus supervision for residents is a fine line
When one is a medical student, pretty much everything one does is directly supervised. Though a student is allowed to assess patients and make recommendations, rarely is a student given the autonomy to make decisions that will affect patients. They practice these decisions, but there is always someone more senior ratifying them.Once a student becomes a resident, things start to change. As residents are physicians, they have the power to write ...
Why unnecessary cesareans is a misnomer
One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.A popular term bandied about is “Unnecesarean”, a catchy ...
Fetal heart rate monitoring is given too much importance
Continuous fetal heart rate monitoring is at its core an almost laughable idea.We are checking a single vital sign and using that vital sign to extrapolate a host of ideas and meanings. OBs that have read strips for years can make some sense of them, but would we give so much meaning to any other single vital sign? Would we do it with an adult? Of course not, but there ...
