Physician

Is the focus on patient safety creating a generation of indecisive doctors who practice without confidence?

Is medical training taking a turn for the worse?

We are so focused on reducing medical errors, as we should, that doctors in training have no leeway to make a mistake. Often times, giving them that space is the only way to give them the confidence to become a competent physician.

Psychiatrist Richard Friedman is noticing that more of his residents are asking him for help, for …

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Should family physicians continue to provide obstetric and maternity care?

Family doctors are doing less obstetric care these days.

As reported by MedPage Today, a study shows that the number of prenatal visits seen by family physicians declined from 11.6% to 6.1% from 1994 to 2004, and perhaps of more concern, 38.6% to 12.9% in rural areas.

It’s not a huge surprise, since these days, obstetricians have absorbed most of the maternity cases. One reason is …

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Did the Canadian health system fail Natasha Richardson?

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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Doctors leaving private practice, and where to go next

It’s becoming apparent that the solo and private practice model of primary care is dying a slow death.

PookieMD interviewed me, as well as retainer physician Kevin Lutz, about the divergent paths that one can take after leaving private practice.

I represent the hospital-owned practice route, and here’s my take:

He opines that, “primary care is the loss leader for the hospital,” explaining that primary care brings business …

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Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then …

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Will reforming the malpractice system be a deal breaker for health reform?

In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.

Good for him for standing up to the trial lawyers, a core constituency of the left.

That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
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When specialists provide primary care, and why patients aren’t complaining

A study recent came out showing that specialists are providing a greater proportion of primary care services to patients.

According to the Annals of Family Medicine, “Researchers looked at more than 1 billion ambulatory visits to U.S. office-based specialists in 2002-04 and found that 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist, while referrals accounted for only …

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Hospitalists assimilate inpatient medicine, is resistance futile?

Hospitalists are here to stay, for good.

MedPage Today reports on a NEJM study, not surprisingly concluding that “hospitalists now account for nearly 40% of inpatient Medicare claims for general internist services, up from less than 10% in 1995.”

That’s a lot.

How will it affect primary care doctors, who increasingly are confined to the office? Well, it’s not a positive as you’d think.

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Should doctors go to work if they’re sick?

The work ethic instilled in most physicians may actually be a detriment to patient care.

In this piece in Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines write about the culture in medicine where doctors are expected to show up for work (via RangelMD.com), no matter what their malady is: “Sick doctors have been known to do rounds while dragging IV poles and receiving fluids for …

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The retail clinic era is over, and why pharmacy-based clinics are doomed to fail

Corporations are finding out what primary care doctors already know: it’s hard to make money only doing office visits.

CVS has announced they are closing 90 of the 550 MinuteClinic locations until next fall’s flu season.

As the WSJ Health Blog comments, “the clinics appear to be showing a pattern sort of like the dot-com bubble, in which some will go away while others survive.”

That’s …

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What is a health coach, and why are they paid $121 an hour?

The movement of “health coaching” is gaining some traction in health care circles.

PookieMD explores the phenomenon, and finds that a health coach, among other duties, “help people clarify their health goals, and implement and sustain behaviors, lifestyles, and attitudes that are conducive to optimal health; guide people in their personal care and health-maintenance activities; and, assist people in reducing the negative impact made on their lives by chronic …

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Should doctors learn to become dentists?

There’s such a shortage of dentists in Maine that primary care doctors are the ones pulling teeth.

Not only does the state have a severe shortage of dentists, poorer patients have trouble seeing one, since few accept those without insurance or with Medicaid.

So that leaves the primary care doctors to pick up the slack and learn to pull teeth, screen for tooth decay, or lance oral …

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Would you waive your right to sue a doctor to obtain free medical care?

What if a retired physician, Harvard-trained no less, wanted to give away medical care?

You’d think the huge demand would make it easier for him to accomplish this, but that’s not the case.

When funding dried up for New York physician Lloyd Hamilton’s free care clinic, he wanted to continue serving the same patients, even depriving himself of a salary. Unfortunately, it wasn’t so easy, as …

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Are academic physicians the next target on the inflated executive salary hit list?

First, Wall Street executives are vilified. Are academic physician-administrators next?

The WSJ Health Blog didn’t do the profession any favors by highlighting the fact that 3 of the top 4 highest paid college employees were physicians at academic medical centers, pulling in $3 million to $4 million per year.

Needless to say, that statistic comes out at an inopportune time, only reinforcing the false public notion that …

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Laborists, and how rising malpractice premiums and the physician payment system are fueling the rise of hospital-only obstetricians

Meet the obstetric version of hospitalists, known as laborists.

Faced with rising malpractice premiums, and the increasing financial pressure to see more patients in the office, more obstetrician/gynecologists are ceasing to deliver babies. In fact, according to Massachusetts’ largest malpractice carrier, more than half of the OB/GYN’s they cover have dropped obstetrics.

It’s no wonder, as “an obstetrician-gynecologist in Massachusetts generally pays between $75,000 and $100,000 …

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One doctor’s unnecessary procedure is another physician’s mortgage payment

“I make my living off unnecessary procedures.”

So will be the rallying cry of some doctors once the true impact of comparative effectiveness research (CER) is felt.

Proponents of CER have been very careful not to associate its evidence-based findings with the coverage decisions of Medicare and other health insurers.

But let’s face it, that eventually has to happen. I see CER as the initial baby …

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How will the economy affect hospitalist salaries?

It’s been said that hospitalists are the fastest growing specialist field in the history of medicine.

Hospitals are constantly recruiting, and the increasing demand is continually pushing salaries up. But, in the midst of the current recession, what does the future hold?

Writing in Today’s Hospitalist (via Dr. RW), Erik DeLue predicts that salaries are likely to plateau, or even fall. Most hospitals …

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Do doctors who use physician-only social networking sites expose themselves to malpractice risk?

One of the newer trends is doctors using social networking sites like Sermo and iMedExchange.

Likened to a “virtual doctor’s lounge,” physicians can ask questions and speak freely knowing their posts will not be seen by, or released to, the public.

Often times, questions about patient management are asked, and it’s nice to have a quick response to queries by a variety of specialists.

In this piece …

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How following hospital quality measures can kill patients

Here’s what happens when you give so much attention and influence to such a crude instrument.

Following quality measures can make or break a hospital’s reputation, especially if they are being widely advertised. Patients often make health care choices based on whether doctors following quality measures.

However, as these measures are currently constructed, they often ignore the nuance surrounding many cases.

Emergency physician WhiteCoat cites …

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What role should nurse practitioners play in primary care?

One proposed way to control costs is to replace primary care doctors with mid-level providers, like nurse practitioners and physician assistants.

Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights.

The ACP comes up with their vision of how nurse practitioners fit within the primary care spectrum. It wisely takes a balanced approach, but, …

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