shutterstock_157734158 The drug test came back abnormal.  There was THC present.  I walked back to Mrs. Johnson and raised my eyebrows. "What's wrong?" she asked, not used to whatever kind of look I was giving her. "Uh, you forgot to mention to me that you smoke weed." She blushed and then smirked.  "Well, yes, I guess I forgot to put that down on the sheet.  I don't ...

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shutterstock_143614549 It's been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we've been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages. What's wrong? That was a trick question.  This is exactly what should be happening when things are going ...

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"Welcome back health care fans!  I'm Dr. Rob." "And I'm Dr. Rob's evil twin." "Good to see you again, Dr. Evil" "Nauseated, as always, to see you, Dr. Rob.  We've got a thrilling lineup in store for you tonight, as the Washington Senators take on the Mighty Docs in the third round of the meaningful use playoffs." "Don't you mean payoffs, evil twin?" "Hilarious, Dr. Dufus.  The meaningful use series did promise big payoffs and better care. But ...

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shutterstock_163737929 "I want to tell you my story now," a patient recently told me, a woman who suffers from many physical and emotional ailments.  She had the diagnosis of PTSD on her problem list, along with hospitalizations for "stress," but I never asked beyond that. "OK," I answered, not knowing what to expect.  "Tell me your story." She paused for about 30 seconds, but I ...

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shutterstock_84146302 I drank the Kool-Aid early.  We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling.  While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.

  • Within a year of implementation, our practice became one of the top installations for our vendor.
  • Within two years, ...

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"I've been getting winded lately." He's a middle-aged man with diabetes.  This kind of thing is a "red flag" on certain patients.  He's one of those patients. "When does it happen?" I ask. "Just when I do things.  If I rest for a few minutes, I feel better." Now the red flag is waving vigorously.  It sounds like it could be exertional angina.  In a diabetic, the symptoms of ischemia (the heart not getting ...

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The documentation I get from everyone is terrible.  Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada.  The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the ...

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Dear ACO General Hospital: Thanks for contacting me about my most recent blog post.  I'm sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information. I know it's kind of embarrassing to have that kind of thing made public, and I am overall ...

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My life changed dramatically when I started my new practice.  The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new.  That's a tough thing to do with four kids, three of whom were in college last fall.  OK, that's a stupid thing to do, but my stupidity has already been well-established. Yet even if the income stayed ...

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I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir, I read about your unique practice online.   I have an 91-year-old ambulatory father who will not go to a doctor.  He definitely is not well and this is the only way I can get him the attention he needs.   He is adamant about not wanting medical interventions, however he still needs to be seen ...

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