“Does my insurance cover this?” I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I -- a gastroenterologist -- do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues. Of course, patients assume that we physicians have an expansive ...

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One thing that gastroenterologists know about is stool. But, I’m not referring to that kind of stool in this post. Follow along. When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool. This metaphor illustrates that the three legs must be equally strong or the stool will not stand. The three pillars of support that a colonoscopist needs include:

We do most of our colonoscopies in our ambulatory surgery center (ASC), which is attached to our office. We are proud of the work that we and our staff do every day and are grateful for the outstanding feedback that we consistently receive from our patients. Some insurance companies will not cover procedures in our ASC so these patients must get "scoped" at the hospital instead. For many of them, this ...

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First, there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking. (Wasn’t the Titanic said to be unsinkable?) We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago. My state of Ohio will now accept Bitcoin as payment for commercial taxes. And, of ...

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Just because something is legal, doesn’t make it right. Just because we enjoy a right of free speech, doesn’t mean we should be verbally insulting people. Just because the Food and Drug Administration (FDA) approves a treatment or a test, doesn’t mean we should pursue it. The FDA has given approval to 23andMe, a private company, to provide genetic testing directly to individuals. The results provide genetic risks of contracting several ...

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Two device salesmen recently came unannounced to our small private gastroenterology practice. They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions. We are physicians, not entrepreneurs. We do not regard the colonoscope as a capitalist tool. Yet, these two salesmen were barraging us with facts and ...

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Does any living, breathing human believe that there is not enough paperwork in our lives? While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under "N" for nonsense. Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical ...

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I prescribe heartburn medicines every day. There’s a gaggle of them now -- Prilosec, Nexium, Prevacid, Protonix -- to name a few. As far as experts know, their primary effect is to reduce the production of stomach acid. This is why they are so effective at putting out your heartburn fire. In simple terms: no acid, no heartburn. I am quite sure that well-meaning physicians like myself do not understand or ...

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Recently, a physician asked my opinion if a patient needed a colonoscopy. My partner was already on the case and I was covering over the weekend. The facts suggested that a colonoscopy was warranted. The patient had a low blood count and had received blood transfusions. Certainly, a bleeding site in the colon, such as a cancer, might be responsible. We do colonoscopies to address similar circumstances on a regular ...

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I just read of a a jury award in excess of $25 million against an insurance company who denied a recommended cancer treatment to a patient who ultimately died.  I do not wish to review here the particulars of this case, and admit that my knowledge is limited by one news report that I read.  While I will not invoke the ubiquitous phrase "fake news," I always bring some ...

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