I admire Paul Tierstein, MD's honest attempt to create a greatly simplified alternative to the  ABMS's Maintenance of Certification (MOC) program called the National Board of Physicians and Surgeons (NBPAS).  I hope he's successful, but I sense there will be large headwinds for the effort ahead. Here's why. The Affordable Care Act (ACA) modified Sections 1848 (k) and 1848 (m) of the Social Security Act, which defines how CMS pays physicians for their services.  ...

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Is it medically professional for a non-profit organization to use physician testing fees to "choose wisely" a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption. After a review of public and tax records, it appears to me this is exactly what has happened. Background In 1999 for reasons that ...

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shutterstock_97947788 As I watch the business world's fascination with the electronic medical record (EMR) and all of the big data that it accumulates, I see more and more processes codified and treatment pathways carefully honed. Only one small thing remains until the computer can tell doctors how to behave based on the developed algorithms: To turn free text in the patient chart ...

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shutterstock_192888809 The phone rang one evening and a pleasant voice was on the other end.  "Hi, my name is nurse so-and-so and I'm the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?" she asked.  "It's very helpful to go over things before and after  your surgery and to answer any questions you might ...

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Another day, another pacemaker, at least so it seemed at first. The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories.  He laid there, smiling, knowing he'd made the right decision after years of struggling with his arrhythmia in other ways.  His heart was showing signs of slight weakening and ...

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He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  "They offered me peritoneal dialysis," he said, "but I decided against it and figured I'd just let nature take its course.  The hospice people are so wonderful -- I've got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, ...

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The dark underbelly of health care is becoming all too visible now. Fresh faces in neatly pressed white coats are in the halls.  Eager.  Enthusiastic.  Clearly very bright.  All hoping for a moment, an experience, an encounter that makes all their hard work worth it.  Surely they'll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights. He was a doctor ...

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shutterstock_117724435 After you've written on a blog for a long time, you begin to ask yourself why.  Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually ...

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As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, "Where to teach?" I do not mean to imply a geographic sense to the word "where" (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a "level." What level do I teach our residents ...

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He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "hellos," "good mornings," and "any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He hurried upstairs to the conference ...

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