Before Michael Jackson, most folks didn’t know what propofol was. Now, patients are asking me for it by name. It’s an awesome drug. It provides a beautiful sedation, is extremely safe and rapidly clears after the procedure. Under its effects, colonoscopy has become a sublime experience. We administer it in a different manner than Conrad Murray did. For those who may have just awakened from a 5 year coma, Conrad Murray ...

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I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 ...

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Recently I read an interesting article on leadership published at Inc.com.  Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in medicine.  In this article, author Curt Hanke writes about the inspiration and leadership positives found in the three simple words:  “I don’t know.” On first blush, we may think that a leader speaking these words may ...

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There was some recent buzz on Twitter about a proposal from a retired plastic surgeon in San Diego who has developed a plan to retrain retired specialists as family practitioners. The idea is that this could alleviate the shortage of primary care physicians that exists now and is predicted to worsen as more people become insured. The 15 module course created by some faculty at the University of California at San ...

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Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean. Specialist’s recommendation (ortho, seen for fracture):

Frequent falls resulting ...

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The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the doctors. Here’s how it works. A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets ...

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I had a nice conversation with a dermatologist at a party recently.  He started complaining about the notes he receives from other physicians.  He used terms like piles and piles of junk. Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system. Several years ago I ranted about the necessity ...

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A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty. When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate ...

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Sophie's Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp. While not of the same gravity,  I have seen the discussion by policy wonks about physician payment reform ...

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Several years ago I wrote an article for physicians on the topic of balance, and one of the suggestions was to place family first.  There are two stories that I have learned since the publication of that article that I would like to pass along. Balance in a doctor’s life is best achieved if there is balance between family and work.  One of the best suggestions is to place family ...

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