When I grow up, I want to practice "free medicine.”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?” Free medicine (FM) is a concept I just created in response to a comment from a reader on a recent blog post.  My reader is a brilliant doc, educator and writer who serves both as mentor and ...

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I can always count on Mr. Wonderful to come up with a timely subject for my blog.  Today’s quotable is, “Dear G-d, I have a problem.  My problem is me!” Some days it feels like I spend half my time trying to convince patients that they need to change their ways in order to get healthy.  I often spend the other half of my time treating the effects of their bad ...

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Click, click, click, “Hello, how are you today?” Click, click, click, “How long have you had a sore throat?” Click, click, click, “Have you had a fever?” Click, click, click, “Have a seat on my exam table, please.” Click, click, click, welcome to my day.  Let me introduce myself, I’m a professional clicker.  I used to be a member of a highly respected and sought after profession; a doctor.  The modern world of government/insurer ...

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I’ve been asked to appear on a radio talk show to discuss one of my blog articles.  It seems that the producers of the show were impressed by my article on the beauty of medicine when it works the way it’s supposed to. “When It Works Right, It’s a Thing of Beauty” was published this summer and is one of my favorite articles.  The practice of medicine is a beautiful thing.  ...

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Today was a great day.  Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing.  Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world.  I know.  I saw it happen today. Today, Mr. X presented with a troublesome history and an even more threatening physical exam.  I was afraid that the disease I was about to diagnose would ...

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Physician Quality Reporting (PQRI) sounds good, doesn’t it?  After all, delivering “quality” is what it’s all about, right?  Maybe.  Maybe the government’s efforts are really designed to improve the quality of the practice of medicine in the US.  Unfortunately, PQRI has fallen short of its reported goal by a long shot. PQRI is time consuming.  PQRI is expensive.  I think PQRI has more potential to do harm than it does to do ...

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"Oh, by the way" are four simple words that cause most docs to shudder.  Yes, shudder.  Your patient signed in for a sore throat, congestion, and cough.  The nurse did her job.  She’s recorded the patient’s chief complaints.  She’s taken the patient’s vital signs and readied the patient to see me, the doc. I take a history, asking questions about the problems that brought the patient to the office.  I ask pertinent ...

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How do you define a “good” doc?  I was reading the patient responses to an article here on KevinMD.com and was saddened by how many of the patients were angry with their docs.  Anger is an unhealthy emotion!  One of the respondents was particularly angry about the “unnecessary” tests her doc performed on her and her family. I have written about the vagaries of the term “unnecessary” in the past.  What ...

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Here today, gone tomorrow.  The older I get, the more often I get the call: “This is the ER at Any Hospital, can you hold for Dr. X?”  Dr. X then comes on the line and tells me my patient had a catastrophic event, that the paramedics and ER crew did everything possible but that the patient expired. My patient had no reason to die.  He was relatively young and healthy. ...

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Participating in a patient’s first heart attack can be an extremely stressful event. Thirty years ago, I was an ER doc.  At the end of a typical shift, I would come home to my wife and, often, would remark about how nervous family docs got when dealing with emergencies like heart attacks. Thirty years later, I’m the family doc and heart attacks are unnerving.  Yes, I know what to do.  We ...

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Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.  Many articles, both pro and con, have been written regarding P4P.  I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.  I also believe that ...

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Have you ever said, “I’m going to be perfectly honest with you” or something to that effect?  Have you ever had someone tell you that they were going to be perfectly honest with you?  Have you ever thought about what statements similar to these really mean?  You should. Trust is an earned commodity and hard to get back once lost.  “Doc, I’m going to be perfectly honest with you” means that, ...

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Welcome to my day from hell.  It is 2 p.m. and I’ve just logged my fifth prior authorization denial of the day.  In simpler terms, five patients will either change their medications or pay for them out of pocket.  Personally, I’m sick of this crap. When it comes to prescribing medication, I am very judicious in my prescribing habits.  According to one of the largest insurers, my percent of generic prescriptions ...

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The problem with phone medicine is that you have to trust what you hear and act accordingly.  Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses.  Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone. Patient’s mom: “My son is sick.  He’s throwing up and has a ...

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According to an article entitled, Binge Drinking Common Among Adults, "about one in every six U.S. adults binges on alcohol." According to the article, "binge drinking -- defined as at least four drinks in one sitting for women and five drinks for men -- carries substantial risks and high costs. It accounts for more than half of the estimated 80,000 annual deaths and three-quarters of the $223.5 billion in economic ...

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Lately, I get the feeling that I’m doing something wrong.  I’m supposed to form a partnership with my patients.  My patients are supposed to be the working partner and I’m supposed to be the consulting partner. My job as the consulting partner is to offer sagely medical advice to the boss (working partner).  As a consultant, I’m supposed to help in the making of key decisions, find the appropriate tools to ...

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I recently wrote that "diagnosis is job number one."  In sports, there are times when two teams share the number one position.  Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking. In medicine, care and diagnosis share the number one spot, working together toward a common goal:  to promote health.  Some would say that, without care, the diagnosis is worthless.  Certainly, ...

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Diagnosis is the foundation on which all care and treatments rest.  If the diagnosis is wrong, most probably so is the treatment.  Diagnosing an illness is an art.  A diagnostician needs to be one part scholar, one part detective, and four parts artist.  He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease ...

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It is obvious to those who know me that I am an avid anti-smoker and work hard to help those afflicted with a tobacco addiction break their habit. Knowing your shortcomings is an important part of being successful. One of my short comings is not knowing when to quit. When it comes to helping smokers stop smoking, I am a zealot. Today, I went to work on one of my smokers, ...

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I wish my patients could see what I see.  I see through a lens sharpened over 30 years of experience.  I see the present and often the future.  Yes, I’m a fortune teller!  Many times, the picture of the future I see is bleak. It’s my job to predict the future and then try to change it.  A friend once told me that he believed life was a movie playing on ...

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