Physician

A referral to a specialist turns patients into currency

Most insurance plans require primary care doctors to refer patients to specialists, like surgeons, cardiologists, and dermatologists.

Without a primary care source of patients, specialists will be without patients, and like any business, their practice will suffer as a result.

In a recent essay, cardiologist Sandeep Jauhar talks about this system. He writes of an ironic paradox where primary care doctors yield a rare display of power: “Specialists are better …

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What is the occupational risk of being a health care worker?

Turns out, we don’t know for sure.

“Despite the very real risk that exists for all health care workers,” writes surgeon Pauline Chen in her recent column, “the actual number of deaths from occupational injuries or infections is unknown. Unlike policemen and firefighters and other high-risk occupations, health care workers have no national registry to track deaths caused by infections or injuries acquired on the job.”

We can only extrapolate from …

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ACP: A practice model for increasing the appeal of General Internal Medicine

The following is the first in a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Much is written and discussed these days about the importance of care coordination by a primary care physician, not only to facilitate patient-centered quality of care, but also to curb the unsustainable growth in the nation’s health care tab. Yet, we hear that the current shortage of …

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Do female doctors hurt physician productivity?

It’s a sensitive subject, previously broached by a Canadian magazine last year.

Now, to pour fuel onto the fire, a recent report finds that, in Canada at least, the growth of female physicians will cause a doctor shortage equivalent to 1,600 physicians over the next decade.

It’s a fact that female doctors work less clinical hours than their male counterparts. According to this article, “women, on average, provided 30 hours a …

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How much time do doctors spend on paperwork?

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

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How doctors should deal with physician rating sites

Stuff the ballot box.

The value of these sites, previously exposed as pretty useless in this Slate piece, is mainly due to the anonymous nature of the comments.

Indeed, even if a doctor wanted to genuinely improve from this form of patient feedback, “posting anonymously on the Web (on sites a doctor does not regularly monitor) is probably the least effective way to accomplish that goal.”

So, physicians are fighting back by …

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Should primary care doctors embrace retail clinics?

Yes, they should.

Whether retail clinics will be a viable venue for the majority of minor medical conditions is in question, but in many cases, doctors seem to be taking an antagonistic front.

As this piece in the NY Times writes, “Many primary-care doctors still denigrate the retail clinics as cheap, unworthy competitors.” That’s precisely the wrong strategy to take.

Witness hospitals who do more to partner, rather than oppose, retail …

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How is concierge medicine doing in the recession?

Surprisingly well.

Although there are plenty of reports where people are splitting their pills, and delaying elective procedures and preventive care, those who are able to afford concierge medicine aren’t cutting back.

In these cases, health is showing resiliency during these tough economic times, and, “With jobs scarce and stress at a peak, many may see a link between continued health and continued employment. And with savings depleted, they recognize that …

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Do we really need fancier, more expensive hospital gowns?

The hospital gown has been much-maligned.

So, in response, textile companies are coming up with innovative replacements that are more functional and stylish, as well as offering better access for medical personnel.

Of course, the biggest obstacle is cost, and with many hospitals financially floundering, spending double the money on hospital gowns is pretty low on the priority list.

Some, like patient Duncan Cross, doesn’t feel …

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Hospitals lose money by preventing patient re-admissions

Preventing re-admissions, or so-called “bounce backs,” is one way for Medicare to cut costs.

Too bad there’s zero economic incentive for most hospitals to do so.

It’s obvious that keeping patients out of the hospital will save money in the long run. Many factors play a role in this, including, appropriate primary care follow-up. But, when hospitals diligently spend money to ensure good post-hospital care, they’re …

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Should doctors who follow evidence-based guidelines be offered liability protection?

As we know, the American Medical Association was part of the consortium that offered to voluntarily rein in health care spending over the next decade.

I’ll leave it to the health policy blogs to discuss the implications, but of course, everyone is asking, “What’s in it for me?”

The AMA tipped their hand a bit in a recent WSJ Health Blog post. It’s well known that President …

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How increasing payments for office visits can help specialists

As we know, the physician reimbursement system is skewed heavily towards performing procedures.

Increasing payments for office visits will obviously help primary care doctors, but as this orthopedic surgeon notes, can also help proceduralists. Studies have shown that in cases of knee osteoarthritis, patients who undergo arthroscopy do not necessarily have better outcomes.

With this in mind, “there are countless examples of orthopedic care that might …

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Should we rename primary care?

The term, primary care, currently garners little respect among medical circles.

Prospective doctors pick up on this during training, making it one reason why they tend to gravitate towards specialties.

So, should “primary care” undergo re-branding?

Internist Robert Centor thinks so, saying, “Primary care suffers in part because so few decision makers really understand how complex primary care is. So I recommend that we no longer …

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6 top medical comments, May 10th, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether emergency physicians best served to staff urgent care centers:
As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is …

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10 Reader Takes you may have missed

With entries dating back to 2004, here are 10 classic Reader Takes:

1. The Happy Hospitalist: All for one and none for all

2. Robin S.: A marriage made in heaven

3. Edwin Leap: The strength of our sameness

4. Dr. Rob: Good humor

5. WhiteCoat: Never say never

6. Sid Schwab: No more and no less a …

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Getting used to torture, and what surgery has to do with it

Can you get desensitized to grisly procedures?

In last week’s NY Times column, Pauline Chen looks at the declassified torture memos and thinks about the first time a doctor-in-training cuts through skin during an operation.

“Most people “” actually anyone who has experienced even a paper cut “” are hesitant to slice through flesh,” writes Dr. Chen. “Aspiring surgeons are no different. Their first efforts are tentative …

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Are East Coast doctors different from their West Coast counterparts?

Maria, a psychiatry fellow who’s practiced medicine on both coasts, notes some differences between the two breeds of physicians.

For instance, regarding hierarchy, on the East, “Physicians wear one color of scrubs. Nurses wear yet another color of scrubs. Medical technicians wear a different color of scrubs from doctors and nurses. It’s very clear who is who”¦ unlike the uniformly scrubbed people on the West Coast.”

And although, …

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Does telemedicine reduce malpractice risk?

The conventional wisdom is that practicing medicine over the telephone exposes doctors to potentially more malpractice lawsuits.

But, is that really the case?

Blogging over at Better Health, physician Alan Dappen, who created an innovative primary care model, suggests not.

His practice, which is based on 24/7 physician availability by phone, solves most patients’ concerns half of the time. He was recently audited by his malpractice …

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Patients do not want their doctors paid on salary

One question that occasionally comes up is whether doctors should be paid a flat salary or not.

Currently, the majority of physicians are paid fee-for-service, meaning that the more procedures or office visits they do, the better they are reimbursed. This, of course, gives a financial incentive to do more, without regard to quality or patient outcomes.

One proposed solution is simply to pay doctors a flat …

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Should specialists be re-trained as primary care physicians?

It appears the forces are aligned to bolster the number of primary care physicians.

Increasing pay has been discussed as one solution, however, any effect from such a move won’t be seen for years to come.

Joe Paduda says we need more immediate results. Training more mid-level providers, like nurse practitioners and physician assistants, or enticing more foreign-trained doctors isn’tt the answer because they too will be …

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