Think for a second about the most treasured drug or device in your medical bag.  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate ... and I do. I also enjoy doing ...

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How much Medicare pays doctors requires context The Centers for Medicare and Medicaid Services released a massive amount of information regarding how much money it paid out to individual doctors. For the policy nerds out there, here is the original data.  For everyone else, here is a simple way to look up how much your own doctor made. I decided to search for myself in the database ...

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During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence -- this fear of what’s ahead -- ...

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The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends -- so he told me at every visit. His visits ...

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A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you ...

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I was recently sent a link to this article entitled “Smile! You’ve Got Cancer” written by Barbara Ehrenreich.  I encourage everyone to read it. The article lives up to its striking title and more.  And I couldn’t help but respond with my perspective. So that you know where I’m coming from, my most personal encounter with cancer is that my grandmother died from cancer. I also treat people with acute ...

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They used to tell us, as physicians, that "if it isn’t on the chart, it didn’t happen."  We could protest all day, to billing companies, insurers or attorneys, "I did that.  It’s assumed.  I always do the same thing every time."  But they would retort, "nope, it’s not in the chart."  So we learned to detail everything, every time, every movement.  Every consideration and justification.  The idea being, our ‘thought process’ ...

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I recently presented my diagnostic talk -- Learning to Think Like a Clinician -- at the Virginia ACP meeting.  Afterwards several physicians wanted to discuss the reasons for diagnostic challenges.  They convinced me that many regulations from CMS and other insurers have influenced policies that increase anchoring and diagnostic inertia. When the emergency department physicians admit to the hospital, they have to give an admission diagnosis.  At least in the United ...

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In my near-decade of practicing emergency medicine I have yet to receive a letter from a hospital congratulating me on how few CT scans I’ve ordered. Nor have I ever received a special award for diverting a potential admission to an outpatient referral instead. Rather, the push has always been the opposite. Fee-for-service models encourage the opposite behavior, and trying to do the most evidenced-based or cost-effective thing is not ...

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A small case with big implications almost escaped my notice this week.  The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection. According to the Globe, the young man went to one of the Boston Emergency Rooms complaining of cough, fever, and chest pains.  Ok, stop right there all you armchair diagnosticians.  What does this man most ...

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