The consult was for “decreased vision and eye pain.” Inpatient consults at the VA hospital come up infrequently, but when they do, it’s inevitably something interesting. As soon as I access the patient’s medical record, a flashing rectangular box encasing a smattering of phrases such as “warning,” “inappropriate behavior,” and “female employees” pops up on the screen. I’m accompanied by one of our female residents, Dr. Smith. Once we leave ...

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Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments.  Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing ...

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For decades, physicians and other health professionals have opened their offices with the assumption that everyone will need to see the doctor eventually. Why? Because that’s where you go if you have a health problem and need to get checked out. As a retina specialist, I assumed that years of training, working with special hand-held lenses, would offer me a diagnostic skill set that very few people in the world have ...

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I would think that when physicians decide where to set up practice, there are things that they would want to think about other than how much money they’ll make.  Yet if one reads Medscape’s current list of the best and worst places to practice, it would appear that money trumps everything else (although Medscape said it also considered factors like “cultural attractions”). What Medscape apparently did not consider ...

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physician pain scale This cartoon is based on data from the 2015 Medscape Physician Compensation Report. Dermatology is on one end, internal medicine on the other.   The other specialties in between.  Doesn't seem to be a trend between the cognitive and procedural specialities, which is a bit surprising.  You'd think the latter would skew towards the "happiness" side. Do you ...

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medpagetodayFrom MedPage Today:

  1. Delaying HCV Tx Reduces Likelihood of Eradication. Delaying treatment of hepatitis C virus infection markedly increased the risk of not being able to clear the virus in these patients.
  2. Paying Residents to Keep Stroke Patients Safe. A team of resident watchdogs and a simple checklist helps one hospital system ...

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Referring physicians are critically important not just for the care and attention we provide patients but also for the referrals we make to specialists. Patients don’t have access to the same data or knowledge that we as healthcare professionals possess, so as referring physicians we can have a significant impact on our patients’ health after they’ve left our immediate care. Big data has given us more information than ever in making ...

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One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider.  This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters.  The format is pretty standard no matter what medium is chosen.  You thank the referring doc for the consult request, you give some brief background info about the patient in question, and ...

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In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no ...

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shutterstock_245379106 It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g., gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists)  Even ophthalmologists have subspecialized into groups ...

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