When I organized my medical practice, I tried to find individuals with great customer service skills and medical knowledge to work in internal medicine practice. We all do our best to meet the needs of our patients, but sometimes, even with the best of efforts, we fall short. For example, a patient requested a large quantity of a medication as a refill early one morning. I saw the fax as I ...

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I have been fortunate in that I have not had to hospitalize any patients in the past four weeks.  This means I have an extra 60 minutes or more to prepare for the workday in my office. The streak ended this weekend when my associate, taking his rotation of being on call, hospitalized one of my patients with pneumonia. In many cases, pneumonia is treated as an outpatient. You receive an ...

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A wise professor of medicine always told me as a young physician, “Eighty-year olds are to be revered and not messed with.”   This is especially true for those 90 or older.  Here in South Florida, there is always some senior citizen telling us today’s 80 is yesterday’s 60, and today’s 70 is yesterday’s 50.  It just isn’t so.  I see this erroneous belief of the elderly having the healing power ...

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One of the advantages of practicing clinical medicine, and seeing patients daily for many years, is you develop your own long-term study regarding certain medical health issues. In the area of hypertension, I have been taught by the best since my internship with pioneers such as Eliseo Perez Stable and Barry Materson at the University of Miami affiliated hospitals, Jackson Memorial Program, ensuring that their trainees were up to the ...

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I watched all three presidential debates this summer with health care being a time-consuming topic for all. Universal health care and Medicare for all, with or without an option for private insurance, were debated and discussed at length. At the same time, NBC Nightly News presented a story documenting that all our antibiotics come from production in China. With globalization policies, which promote moving production to lower-cost overseas factories, there is ...

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A 67-year-old woman with a high-stress job had a vigorous disagreement with her neighbors last week. She developed severe substernal chest pain and called 911 fearing a heart attack. She is thin, has never smoked, has normal blood pressure and normal cholesterol. She is not a diabetic and runs on a treadmill for two hours at five miles per hour with an elevation for two hours four times a week. ...

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Prevention of heart disease has centered on smoking cessation, controlling blood pressure, achieving an appropriate weight, regular exercise, control of blood sugar, and control of your cholesterol.  Despite addressing and controlling these items, individuals still have heart attacks and strokes and vascular events. Researchers are now directing their attention to a dietary metabolite of red meat called trimethlamine N-oxide or TMAO. Recent peer-reviewed and published studies have shown ...

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Reuters recently published an article on skilled nursing facilities and post-hospital stays.  They discussed the often-lengthy time between hospital discharge and the patient being seen by a physician or “an advanced care practitioner.” Older, more infirm and cognitively impaired patients tend to be seen later than other patients. The later you are seen, the more likely it is that you will be sent back to the acute care ...

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I recently read an article in a peer-reviewed journal citing the benefits of a few eggs per week as part of a low carbohydrate dietary intervention for Type 2 diabetes.  The information was so meaningful about a controversial food source of protein that I decided to write about it in my blog and pass it along to my patients.  Three days later the American Heart Association and American College of ...

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I received an email from our hospital accreditation coordinator/quality coordinator in a manner that wasn’t clear if it was directed to me personally or if it was sent to the entire medical staff.  It said that she was reviewing the Joint Commission's recent survey which found that the charts did a poor job of reflecting the patient’s “code status.”  The institution only received a 40 percent rating. Some patients were listed ...

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My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now.  The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly. This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent.  Most of the members of the hospital medical staff have absolutely no ...

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My friend and practice advisor showed me two very negative anonymous reviews of my practice this week. Both were posted within a one-month winter period and were written about family members. They were not written by patients. My staff and I tried diligently to identify the stated situations as they did not resonate with any of us. Unfortunately, we were unsuccessful. That frustrates each of us. Combined, these reviews were aggressive and ...

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On a daily basis, patients of mine come in for office visits complaining of wear and tear injuries, as well as aches and pains, and their methods of dealing with chronic pain. As we all know, aging is a part of the normal life process. For instance, as we approach 70 years old, we typically lose three-quarters of our functioning kidney cells (nephrons) but do well with our limited reserve as ...

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I have received several phone calls in the last few weeks from young adults requesting information about their last vaccinations. They are traveling to areas of the world that suggest or require certain vaccines and do not remember if they had them or not. Others are applying for positions of employment which require travel and the employer’s human resources department needs the patient’s updated vaccination records. When we tell them that ...

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For the last 25 years, I have had the privilege of being a designated airman medical examiner by the Federal Aviation Administration. To earn that privilege, it required flying to FAA headquarters and taking a one-week training course followed by refresher training material every three years. The FAA grades medical examiners annually by our judgment and decision-making. The nature of the questions we are required to ask the pilot candidates, and ...

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Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get ...

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We have a new electronic medical health record system at our hospital. It was introduced with what I believe is a short and ineffective training program for physicians followed by a far too short on-location use of experts to help the doctors and nurses learn the new system. It is frankly a pain in the neck to access the computer from outside the hospital due to the multiple layers of ...

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I practiced general internal medicine from June 1979 until November 2003. Immediately after training, I became an employed physician of an older internist covering my employer’s patients and building my practice for two years before embarking on my own. I saw 20 or more patients per day in addition to providing hospital care and visiting patients as they recovered in nursing homes. As managed care made its clout felt by kidnapping ...

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My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader. Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a ...

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A study published recently in JAMA Internal Medicine looked at 650,651 Medicare patients hospitalized in 2013. It showed that when patients were cared for by their own outpatient physician, they had a slightly better outcome than when the patients were attended to by full-time hospital-based specialists who had not previously known them. As an internal medicine physician who maintains hospital privileges, as well as caring for patients in ...

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