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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"Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.” Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final. “Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.” I ...

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burnout To the literal-minded, burning out is the fate of light bulbs and matches.  But whether you read the popular press or medical journals today, you’re likely to find writers who are deeply concerned about physician burnout. What defines physician burnout, and who exactly is suffering from it?  Is burnout an actual clinical syndrome, a slang term connoting fatigue and boredom, or a hazy ...

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acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I'm an alternate, but ...

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Don’t ask me nothin’ about nothin’, I just might tell you the truth.  – Bob Dylan I just read an interesting post by Dr. Jennifer Gunter. Apparently, the entirety of what we are doing here at Dr. Whitecoat, and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training? According to ...

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