Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness ...

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It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to  negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer. If you have been ...

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There's nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone's expectations. Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be ...

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The ability to critically assess the validity of a clinical trial is one of many important skills that a physician strives to develop. This skill helps guide clinical decision-making, and there are a number of things that we are trained to look for to help determine the validity of any given study. Right at the top of the list of factors that go into this appraisal is that of study ...

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There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable. I remember a particular patient from 20 years ago for a very different ...

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Can you say “reactance”?  Don’t feel bad, I wasn’t familiar with the term either until recently.  But as you will see, anyone that has ever been a patient will catch on pretty quickly as to what reactance is and how it works. Reactance is how we respond to something that threatens to limit or eliminate our behavioral freedom.  I recently experienced reactance in the course of “prepping” for a colonoscopy.   The ...

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Using data from Medicare and private insurers, analysts at the RAND Corporation found that the rate of involvement of anesthesiologists for upper GI endoscopy and colonoscopy in low-risk patients had risen steadily over the last few years and is estimated to add $1.1 billion in what may be unnecessary health care costs. There was wide regional variation in the use of anesthesiologists which suggests that some or most of the ...

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"It is getting worse everyday." "Medicare fix at the last moment." "Too much paperwork not enough time with patients." "ACO’s and bundling." The headlines scream at us everyday. If we have one word that underlies the medical community it is fear. The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching ...

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If you really want to know what’s going on inside your colon, don’t show-up for a colonoscopy without a clean colon. Many say that preparing for the colonoscopy is the worst part of the entire exam. But, it just so happens that it’s also the most important part. If the prep is done right, it’s easier for your doctor to see not only big polyps but also flat polyps, which can be ...

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I was jogging one day while on a business trip in LA and collapsed during the run.  Within hours, I was at the hospital at UCLA Medical Center on a gurney headed for a CT scan of my abdominal cavity.  I remember telling the ER physicians that I was a doctor and recommending my own course of action.  As my advice to the ER doctors went largely ignored, I realized, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old woman is evaluated for a 6-month history of right upper quadrant abdominal pain that has slowly increased in intensity and is worse on deep inspiration. The patient is otherwise well, and her only medication is an oral contraceptive pill that she has taken ...

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Losing weight can help lower your chances for cancer if you’re overweight or obese. But not just any weight-loss plan will give your body the nutrients it needs to fight off diseases like cancer. Below, I’ve separated out the good from the bad among popular diets. Good nutrition is not a fast fix Diets that make the “good list” encourage long-term change. They also give you a variety of options from all ...

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As we enter 2012, many patients will be changing to new insurance plans. And for a few, deductibles will be rising. One thing that's emphasized in the Affordable Care Act, however, is that preventive services would remain "free." However, consider this story of a man, who thought he wouldn't have to pay for his screening colonoscopy, instead was charged over $1,000 for the ...

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