Dr. Grumpy has lost his neurology mojo over time. Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape. Yesterday I turned away a good hospital case, and told them to find someone else. The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case. 28-year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). ...

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We had an interesting dilemma in the office. You see, being pulmonologists we treat people with asthma, and one of the more useful drugs we have in the ammunition belt is a medication called omalizumab (Xolair). Among patients in whom it’s indicated, particularly those with severe allergic asthma, the effects can be dramatic and life altering. The problem with this drug is the cost. Actually also the administration. And the anaphylaxis. Not to mention all the ...

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Not everything that counts can be measured. Not everything that can be measured counts. -Albert Einstein Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician's movements at scientific conferences (so called "tag and release") using RFID tags embedded in attendees name badges at national scientific sessions. Having had personal experience with the American College of Cardiology meeting, this technology was also embedded in the name badges ...

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You may have noticed the rash of medical news spewing from your favorite news outlets with greater frequency. As a medical professional you probably cringe as you envision the calls that are about to flood your office, "Doctor Smith, I heard a report on the news that this drug you prescribed to help me quit smoking is bad for my health!" or, "I want a referral to The Hoffenheimer Institute ...

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What's it like to be on call? Hospitalist ZDoggMD knows.

The scene was picture perfect, an absolute characterization of a tropical island paradise.  White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean. I found no pleasure in it.  Perhaps it was the heat, or that my new wife and I had been travelling for six months?  Or that we had been on many other tropical islands and amazing places in ...

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At Camden Community Hospital (a fictional hospital), Shana, a senior RN, is leading a team meeting to discuss standardizing the handoff of patients between shifts.  She quickly looks over the team members, who are chatting among themselves, some not very quietly.  "May I have your attention, please," she says.  Some stop talking and others keep on.  She raps her hand on the table and now she has everyone’s attention. ...

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Recently a good friend asked me to recommend an excellent primary care physician in New York City. When no one immediately came to mind, I asked a couple of doctor-friends who trained in New York. One friend, a cardiologist, gave me two names—one was a rheumatologist, who also practices general medicine, and the other an infectious disease doctor by training. My initial reaction to my cardiologist friend’s suggestion that ...

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Today I became a patient.  If you follow me on Twitter, then by now you know what happened.  Yes, I am embarrassed by what happened, but I’ll relinquish my HIPAA right to privacy for this moment. This afternoon I swam nose-first into the sidewall in the pool.  (I haven't been swimming in awhile and I forgot to bring goggles, so I wasn't really looking.  Laugh all you want ...)  It ...

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Pay for performance.  It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more. What could be simpler, right? Wrong. Not all patients are created equal.  Some are highly educated, highly literate, highly motivated to prioritize health.  They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying ...

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